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Wykoff CC, Abreu F, Adamis AP, Basu K, Eichenbaum DA, Haskova Z, Lin H, Loewenstein A, Mohan S, Pearce IA, Sakamoto T, Schlottmann PG, Silverman D, Sun JK, Wells JA, Willis JR, Tadayoni R. Efficacy, durability, and safety of intravitreal faricimab with extended dosing up to every 16 weeks in patients with diabetic macular oedema (YOSEMITE and RHINE): two randomised, double-masked, phase 3 trials. Lancet 2022; 399:741-755. [PMID: 35085503 DOI: 10.1016/s0140-6736(22)00018-6] [Citation(s) in RCA: 135] [Impact Index Per Article: 67.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/29/2021] [Accepted: 11/25/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND To reduce treatment burden and optimise patient outcomes in diabetic macular oedema, we present 1-year results from two phase 3 trials of faricimab, a novel angiopoietin-2 and vascular endothelial growth factor-A bispecific antibody. METHODS YOSEMITE and RHINE were randomised, double-masked, non-inferiority trials across 353 sites worldwide. Adults with vision loss due to centre-involving diabetic macular oedema were randomly assigned (1:1:1) to intravitreal faricimab 6·0 mg every 8 weeks, faricimab 6·0 mg per personalised treatment interval (PTI), or aflibercept 2·0 mg every 8 weeks up to week 100. PTI dosing intervals were extended, maintained, or reduced (every 4 weeks up to every 16 weeks) based on disease activity at active dosing visits. The primary endpoint was mean change in best-corrected visual acuity at 1 year, averaged over weeks 48, 52, and 56. Efficacy analyses included the intention-to-treat population (non-inferiority margin 4 Early Treatment Diabetic Retinopathy Study [ETDRS] letters); safety analyses included patients with at least one dose of study treatment. These trials are registered with ClinicalTrials.gov (YOSEMITE NCT03622580 and RHINE NCT03622593). FINDINGS 3247 patients were screened for eligibility in YOSEMITE (n=1532) and RHINE (n=1715). After exclusions, 940 patients were enrolled into YOSEMITE between Sept 5, 2018, and Sept 19, 2019, and 951 patients were enrolled into RHINE between Oct 9, 2018, and Sept 20, 2019. These 1891 patients were randomly assigned to faricimab every 8 weeks (YOSEMITE n=315, RHINE n=317), faricimab PTI (n=313, n=319), or aflibercept every 8 weeks (n=312, n=315). Non-inferiority for the primary endpoint was achieved with faricimab every 8 weeks (adjusted mean vs aflibercept every 8 weeks in YOSEMITE 10·7 ETDRS letters [97·52% CI 9·4 to 12·0] vs 10·9 ETDRS letters [9·6 to 12·2], difference -0·2 ETDRS letters [-2·0 to 1·6]; RHINE 11·8 ETDRS letters [10·6 to 13·0] vs 10·3 ETDRS letters [9·1 to 11·4] letters, difference 1·5 ETDRS letters [-0·1 to 3·2]) and faricimab PTI (YOSEMITE 11·6 ETDRS letters [10·3 to 12·9], difference 0·7 ETDRS letters [-1·1 to 2·5]; RHINE 10·8 ETDRS letters [9·6 to 11·9], difference 0·5 ETDRS letters [-1·1 to 2·1]). Incidence of ocular adverse events was comparable between faricimab every 8 weeks (YOSEMITE n=98 [31%], RHINE n=137 [43%]), faricimab PTI (n=106 [34%], n=119 [37%]), and aflibercept every 8 weeks (n=102 [33%], n=113 [36%]). INTERPRETATION Robust vision gains and anatomical improvements with faricimab were achieved with adjustable dosing up to every 16 weeks, demonstrating the potential for faricimab to extend the durability of treatment for patients with diabetic macular oedema. FUNDING F Hoffmann-La Roche.
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Affiliation(s)
- Charles C Wykoff
- Retina Consultants of Texas, Retina Consultants of America, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA.
| | | | | | - Karen Basu
- Roche Products (Ireland), Dublin, Ireland
| | - David A Eichenbaum
- Retina Vitreous Associates of Florida, St Petersburg, FL, USA; Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | | | - Hugh Lin
- Genentech, South San Francisco, CA, USA
| | - Anat Loewenstein
- Tel Aviv Medical Center and Tel Aviv University, Tel Aviv, Israel
| | | | - Ian A Pearce
- Royal Liverpool University Hospital, Liverpool, UK
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University, Kagoshima, Japan
| | | | | | - Jennifer K Sun
- Joslin Diabetes Center, Beetham Eye Institute, Harvard Department of Ophthalmology, Boston, MA, USA
| | - John A Wells
- Palmetto Retina Center, Retina Consultants of America, Columbia, SC, USA
| | | | - Ramin Tadayoni
- Université de Paris, AP-HP, Lariboisière, Saint Louis, Paris, France; Fondation Adolphe de Rothschild Hospitals, Paris, France
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Richer S, Novil S, Gullett T, Dervishi A, Nassiri S, Duong C, Davis R, Davey PG. Night Vision and Carotenoids (NVC): A Randomized Placebo Controlled Clinical Trial on Effects of Carotenoid Supplementation on Night Vision in Older Adults. Nutrients 2021; 13:3191. [PMID: 34579067 PMCID: PMC8471486 DOI: 10.3390/nu13093191] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/07/2021] [Accepted: 09/10/2021] [Indexed: 12/22/2022] Open
Abstract
Twilight and low luminance levels are visually challenging environments for the elderly, especially when driving at night. Carotenoid rich diets are known to increase macular pigment optical density (MPOD), which in turn leads to an improvement in visual function. It is not known whether augmenting MPOD can lead to a decrease in vision related night driving difficulties. Additionally, it is unknown if carotenoid supplementation provides additional measurable benefits to one's useful field of view (UFOV) along with a decreased composite crash risk score. The aim of the study was to evaluate changes in night vision function and UFOV in individuals that took carotenoid vitamin supplements for a six-month period compared to a placebo group. METHODS A prospective, randomized, double-blind, six-month trial of a 14 mg zeaxanthin/7 mg lutein-based supplement was carried out. Participants were randomized into active or placebo group (approx 2:1). RESULTS n = 33 participants (26 males/7 females) participated with 93% capsule intake compliance in the supplemented group (n = 24) and placebo group (n = 9). MPOD (mean/standard error SE) in the active group increased in the Right eye from 0.35 density units (du)/0.04 SE to 0.41 du/0.05 SE; p < 0.001 and in the Left eye from 0.35 du/0.05 SE to 0.37 du, p > 0.05). The supplemented group showed significant improvements in contrast sensitivity with glare in both eyes with improvements in LogMAR scores of 0.147 and 0.149, respectively (p = 0.02 and 0.01, respectively), monocularly tested glare recovery time improved 2.76 and 2.54 s, respectively, (p = 0.008 and p = 0.02), and we also noted a decreased preferred luminance required to complete visual tasks (p = 0.02 and 0.03). Improvements in UFOV scores of divided attention (p < 0.001) and improved composite crash risk score (p = 0.004) were seen in the supplemented group. The placebo group remained unchanged. CONCLUSIONS The NVC demonstrates that augmenting MPOD in individuals with difficulty in night vision showed measurable benefits in numerous visual functions that are important for night vision driving in this small sample RCT. Additionally, we observed an improvement in UFOV divided attention test scores and decreased composite risk scores.
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Affiliation(s)
- Stuart Richer
- Captain James A Lovell Fed Health Care Facility, North Chicago, IL 60064, USA;
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA; (T.G.); (A.D.); (S.N.); (C.D.)
| | - Steven Novil
- Captain James A Lovell Fed Health Care Facility, North Chicago, IL 60064, USA;
| | - Taylor Gullett
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA; (T.G.); (A.D.); (S.N.); (C.D.)
| | - Avni Dervishi
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA; (T.G.); (A.D.); (S.N.); (C.D.)
| | - Sherwin Nassiri
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA; (T.G.); (A.D.); (S.N.); (C.D.)
| | - Co Duong
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA; (T.G.); (A.D.); (S.N.); (C.D.)
| | - Robert Davis
- Davis Eye Care Associates, Oak Lawn, IL 60453, USA;
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Olmedilla-Alonso B, Rodríguez-Rodríguez E, Beltrán-de-Miguel B, Estévez-Santiago R, Sánchez-Prieto M. Predictors of macular pigment and contrast threshold in Spanish healthy normolipemic subjects (45-65 years) with habitual food intake. PLoS One 2021; 16:e0251324. [PMID: 34043644 PMCID: PMC8159008 DOI: 10.1371/journal.pone.0251324] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 04/26/2021] [Indexed: 12/14/2022] Open
Abstract
Introduction The dietary carotenoids lutein (L) and zeaxanthin (Z) are transported in the bloodstream by lipoproteins, sequestered by adipose tissue, and eventually captured in the retina where they constitute macular pigment. There are no L&Z dietary intake recommendations nor desired blood/tissue concentrations for the Spanish general population. Our aim was to assess the correlation of L&Z habitual dietary intake (excluding food supplements), resulting serum concentrations and lipid profile with macular pigment optical density (MPOD) as well as the contrast sensitivity (CT), as visual outcome in normolipemic subjects (n = 101) aged 45–65. Methods MPOD was measured by heterochromatic flicker photometry, serum L&Z by HPLC, the dietary intake by a 3-day food records and CT using the CGT-1000-Contrast-Glaretester at six stimulus sizes, with and without glare. Results Lutein and zeaxanthin concentrations (median) in serum: 0.361 and 0.078 μmol/L, in dietary intake: 1.1 mg L+Z/day. MPOD: 0.34du. L+Z intake correlates with their serum concentrations (rho = 0.333, p = 0.001), which in turn correlates with MPOD (rho = 0.229, p = 0.000) and with fruit and vegetable consumption (rho = 0.202, p = 0.001), but not with lutein+zeaxanthin dietary intake. MPOD correlated with CT, with and without glare (rho ranges: -0.135, 0.160 and -0.121, –0.205, respectively). MPOD predictors: serum L+Z, L+Z/HDL-cholesterol (β-coeficient: -0.91±0.2, 95%CI: -1.3,-0.5) and HDL-cholesterol (R2 = 15.9%). CT predictors: MPOD, mainly at medium and smaller visual angles (corresponding to spatial frequencies for which sensitivity declines with age) and gender (β-coefficients ranges: -0.95,-0.39 and -0.13,-0.39, respectively). Conclusion A higher MPOD is associated with a lower ratio of L+Z/HDL-cholesterol and with a lower CT (higher contrast sensitivity). The HDL-cholesterol would also act indirectly on the CT improving the visual function.
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Affiliation(s)
- Begoña Olmedilla-Alonso
- Department of Metabolism and Nutrition, Institute of Food Science, Technology and Nutrition (ICTAN-CSIC), Madrid, Spain
- * E-mail:
| | - Elena Rodríguez-Rodríguez
- Department of Chemistry in Pharmaceutical Sciences, Faculty of Pharmacy, Complutense University of Madrid, Madrid, Spain
| | - Beatriz Beltrán-de-Miguel
- Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, Madrid, Spain
| | - Rocío Estévez-Santiago
- Department of Metabolism and Nutrition, Institute of Food Science, Technology and Nutrition (ICTAN-CSIC), Madrid, Spain
- Faculty of Experimental Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Madrid, Spain
| | - Milagros Sánchez-Prieto
- Department of Metabolism and Nutrition, Institute of Food Science, Technology and Nutrition (ICTAN-CSIC), Madrid, Spain
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Simonett JM, Ambady P, Neuwelt EA, Skalet AH, Lin P. Maculopathy Associated With Osmotic Blood- Brain Barrier Disruption and Chemotherapy in Patients With Primary CNS Lymphoma. Ophthalmic Surg Lasers Imaging Retina 2021; 51:S5-S12. [PMID: 32484895 DOI: 10.3928/23258160-20200108-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/10/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To describe the incidence, characteristics, and risk factors of a pigmentary maculopathy in patients with primary central nervous system (CNS) lymphoma treated with blood-brain barrier disruption (BBBD) therapy. PATIENTS AND METHODS This retrospective chart review included patients with biopsy-proven primary CNS lymphoma treated with or without BBBD therapy who underwent an ophthalmic examination after starting systemic treatment. Clinical data and all available retinal imaging were analyzed. RESULTS Fifty-eight patients met inclusion criteria. Twenty-one of 36 patients treated with BBBD therapy had a bilateral pigmentary maculopathy. None of the 22 patients treated with conventional chemotherapy had similar changes. Additional findings in patients treated with BBBD included geographic retinal pigment epithelium atrophy, subretinal fluid, and in one case, choroidal neovascularization. Some cases of maculopathy resulted in reduced visual acuity. The presence of a pigmentary maculopathy was associated with a higher number of BBBD treatment sessions (20.1 vs 13.3, P = .016), but not vitreoretinal lymphoma involvement or intravitreal methotrexate injections. CONCLUSION In this cohort, 58.3% of patients with primary CNS lymphoma treated with BBBD and chemotherapy were found to have a bilateral pigmentary maculopathy. This maculopathy can result in reduced visual acuity and is associated with the number of BBBD treatment sessions. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:S5-S12.].
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Hayashi Y, Tatsumi T, Oshitari T, Kaiho T, Takatsuna Y, Arai M, Baba T, Yamamoto S. Comparisons of One to Three Monthly Injections of Aflibercept for Diabetic Macular Edema by Practical Protocol. J Diabetes Res 2021; 2021:1374891. [PMID: 33628832 PMCID: PMC7896872 DOI: 10.1155/2021/1374891] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 01/20/2021] [Accepted: 02/01/2021] [Indexed: 02/08/2023] Open
Abstract
The purpose of this study was to compare the efficacies of one initial intravitreal injection of aflibercept followed by a pro re nata (PRN; 1+PRN) regimen to those of three consecutive monthly injections followed by the PRN (3+PRN) regimen for diabetic macular edema (DME) with practical protocols. The medical records of 95 eyes of 71 cases that were diagnosed with DME and had received intravitreal aflibercept (IVA) injections were reviewed. Fifty-seven eyes had received IVA with the 1+PRN regimen, and 38 eyes had received IVA with the 3+PRN regimen. The best-corrected visual acuity (BCVA) and the central macular thickness (CMT) were measured at the baseline and at 1, 3, 6, and 12 months after the IVA. The mean number of injections of the 1+PRN group was 2.9 ± 1.7, which was significantly fewer than that of the 3+PRN group at 4.6 ± 1.4 (P < 0.001). The change of the mean BCVA before and after the IVA at 12 months of the 3+PRN group was -0.14 ± 0.17 logMAR units which was significantly better than that of the 1+PRN group of -0.045 ± 0.25 logMAR units (P = 0.02). The change of the CMT before and after the IVA at 6 months of the 3+PRN group was -141.3 ± 152.4 μm which was significantly more than that of the 1+PRN group at -86.1 ± 117.8 μm (P = 0.013). Although the mean number of injections was more than that in the 1+PRN regimen, the 3+PRN regimen had better visual outcomes at 12 months. In a practical protocol, we recommend the 3+PRN regimen for patients with DME (IRB#3541).
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Affiliation(s)
- Yuko Hayashi
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tomoaki Tatsumi
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Toshiyuki Oshitari
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
- Department of Ophthalmology, International University of Health and Welfare, Narita, Japan
| | - Tomomi Kaiho
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoko Takatsuna
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Miyuki Arai
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takayuki Baba
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Shuichi Yamamoto
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
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Tanabe H, Obana A, Yamamoto S, Ichikumi K, Gohto Y, Seto T, Moriyama T. Potential roles of MNREAD acuity charts and contrast/glare sensitivity in Ranibizumab treatment of branch retinal vein occlusion. PLoS One 2020; 15:e0235897. [PMID: 32649680 PMCID: PMC7351188 DOI: 10.1371/journal.pone.0235897] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 06/24/2020] [Indexed: 11/19/2022] Open
Abstract
Background/Objectives To investigate the potential utility of MNREAD acuity charts and contrast/glare sensitivity (CGS) assessment for evaluating the efficacy of an initial treatment with ranibizumab (Lucentis®) for branch retinal vein occlusion (BRVO). Methods Intravitreal injections of ranibizumab were administered in 43 eyes of 43 treatment-naïve patients with BRVO. Efficacy was assessed 1 month later. Best-corrected far/near visual acuity (BCFVA/BCNVA), MNREAD parameters (reading acuity [RA], maximum reading speed [MRS], critical print size [CPS]), CGS (CS/GS), and central macular thickness (CMT) in optical coherence tomography (OCT) before and after treatment were evaluated. The area (superior/inferior) affected by BRVO was determined by fluorescein angiography. Results All parameters improved significantly following treatment (p < 0.05), and all MNREAD and CGS parameters were significantly correlated with BCVA in the treated eye before and after treatment (p < 0.01). The changes in BCFVA, BCNVA, MRS, and CS were significantly correlated with the amount of change in CMT (p < 0.007; r = 0.415, 0.528, -0.465, and -0.508, respectively). MRS exhibited a percentage change that was significantly correlated with that in CMT (p < 0.007; r = -0.511). Additionally, MRS exhibited the lowest threshold CMT (397 μm) at which the most significant change in improvement was observed. CMT was less likely to improve if BRVO occurred at a superior site than if it occurred at an inferior site (0.05 < p = 0.07 < 0.1). Conclusions MNREAD and CGS testing were useful for evaluating BRVO treatment efficacy. MRS might be a valuable index for evaluating treatment success and making treatment decisions.
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Affiliation(s)
- Hirotaka Tanabe
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
- * E-mail: (AO); (HT)
| | - Akira Obana
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
- * E-mail: (AO); (HT)
| | - Sachiko Yamamoto
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Kiyomi Ichikumi
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Yuko Gohto
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Takahiko Seto
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Takanobu Moriyama
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
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Zamorano Martín F, Rocha-de-Lossada C, Rachwani Anil R, Borroni D, Rodriguez Calvo de Mora M, España Contreras M. Tamoxifen maculopathy: The importance of screening and long follow-up. J Fr Ophtalmol 2020; 43:727-730. [PMID: 32620415 DOI: 10.1016/j.jfo.2019.12.004] [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: 12/15/2019] [Accepted: 12/27/2019] [Indexed: 11/17/2022]
Abstract
We report a case of a patient treated with tamoxifen 20mg daily as hormone therapy for breast cancer. On regular ophthalmological follow-up, tamoxifen maculopathy was detected on SD-OCT (Spectral Domain Optic Coherence Tomography, Carl Zeiss Meditec®), so the medication was discontinued. Despite discontinuation of the medication, the maculopathy progressed over time. We have been following our patient for seven years. Tamoxifen may produce a toxic maculopathy which may progress despite discontinuation of the medication. We consider our case interesting, given the lengthy follow-up of the patient with sequential SD-OCT images. To the best of our knowledge, our case represents the longest follow-up period for a patient with tamoxifen maculopathy. Moreover, we would like to stress the importance of screening in asymptomatic patients on this medication, in order to detect early pathological signs.
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Affiliation(s)
- F Zamorano Martín
- Hospital Regional Universitario de Málaga, Ophthalmology Department, Spain.
| | - C Rocha-de-Lossada
- Hospital Regional Universitario de Málaga, Ophthalmology Department, Spain
| | - R Rachwani Anil
- Hospital Regional Universitario de Málaga, Ophthalmology Department, Spain
| | - D Borroni
- Royal Liverpool University Hospital, Spain
| | | | - M España Contreras
- Hospital Regional Universitario de Málaga, Ophthalmology Department, Spain
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Sánchez-Guillén I, Almorín-Fernández-Vigo I, Fernández-Vigo JI, de-Pablo-Gómez-de-Liaño L, Kudsieh B, Fernández-Vigo JA. Assessment of changes in the macula and optic nerve head using optical coherence tomography in patients with attention deficit hyperactivity disorder. ACTA ACUST UNITED AC 2020; 95:271-278. [PMID: 32423628 DOI: 10.1016/j.oftal.2020.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 02/25/2020] [Accepted: 02/27/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION To assess if there are any differences in macular and papillary thickness using optical coherence tomography (OCT) in patients with attention deficit hyperactivity disorder (ADHD) compared with a control group, including if there are differences between ADHD patients with and without treatment. METHODS Prospective observational study including 92 eyes of 46 patients divided into 2 groups: 46 eyes of 23 patients with ADHD, and a control group of 46 eyes of 23 healthy patients. The group of patients with ADHD was subdivided into those on treatment with methylphenidate (n=28) and those not on treatment (n=18). The macular thickness, the ganglion cell complex (GCC), and the retinal nerve fibre layer (RNFL) at the papillary level were measured in 12 sectors. RESULTS A lower central macular thickness was observed in the ADHD patients than in the controls (257.4±20μm versus 267.5±20μm, P=.013), with no differences observed in the GCC (P=.566), or in the RNFL (P=.095). There were no differences in the patients with ADHD with and without treatment, as regards macular thickness and the GCC (P=.160 and P=.375 respectively), but a lower foveal thickness (P=.018) and RNFL in 5/12 sectors at the papillary level (P=.033) were observed in those without treatment. CONCLUSIONS A lower macular thickness was observed in patients with ADHD than in controls. In addition, patients with ADHD without treatment had a lower thickness of the fovea and RNFL than those patients on treatment.
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Affiliation(s)
- I Sánchez-Guillén
- Centro Internacional de Oftalmología Avanzada, Badajoz, España; Departamento de Oftalmología, Hospital de Zafra, Zafra, Badajoz, España.
| | | | - J I Fernández-Vigo
- Centro Internacional de Oftalmología Avanzada, Madrid, España; Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - L de-Pablo-Gómez-de-Liaño
- Centro Internacional de Oftalmología Avanzada, Madrid, España; Departamento de Oftalmología, Hospital 12 de Octubre, Madrid, España
| | - B Kudsieh
- Centro Internacional de Oftalmología Avanzada, Madrid, España; Departamento de Oftalmología, Hospital Puerta de Hierro, Majadahonda, Madrid, España
| | - J A Fernández-Vigo
- Centro Internacional de Oftalmología Avanzada, Badajoz, España; Centro Internacional de Oftalmología Avanzada, Madrid, España; Facultad de Medicina, Universidad de Extremadura, Badajoz, España
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Taipale C, Lindholm JM, Kaarniranta K, Tuuminen R. Comparison of Two Different Treat-and-Extend Protocols with Aflibercept in Wet Age-Related Macular Degeneration: Two-Year Results. Adv Ther 2020; 37:2256-2266. [PMID: 32277343 DOI: 10.1007/s12325-020-01312-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 02/24/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION To optimize the aflibercept treat-and-extend protocol in wet age-related macular degeneration (wAMD) beyond the 1-year interim report. METHODS This 2-year prospective randomized clinical trial included 52 eyes from 52 patients with treatment-naïve wAMD. After the induction phase of three monthly aflibercept injections, patients were randomized 1:1 to two different treat-and-extend protocols. In the treat-and-extend protocol with moderate extensions (T&Em), the treatment interval was extended 1 week at a time up to 12 weeks, and then by 2 weeks up to 16 weeks. In the treat-and-extend protocol with rapid extensions (T&Er), the treatment interval was initially extended to 8 weeks, and then by 2 weeks up to 16 weeks. Main outcome measure was the number of given aflibercept injections. RESULTS At the study end point at 2 years, the mean visual gain from the baseline was 7.9 ± 14.5 letters in T&Em, compared to 10.8 ± 16.5 letters in T&Er protocol (P = 0.726). The mean decrease in central subfield macular thickness was 203.0 ± 167.4 µm in T&Em and 192.3 ± 160.2 µm in T&Er protocol (P = 0.822). Treatment interval was 10.3 ± 3.3 weeks in T&Em and 11.7 ± 3.5 in T&Er protocol (P = 0.164) at the end of year 2. The total number of injections in 2 years was 14.1 ± 3.1 in T&Em and 11.6 ± 2.0 in T&Er (P = 0.002), and the number of injections during the second year was 5.4 ± 1.8 and 4.4 ± 1.4, respectively (P = 0.043). A total of 71% of the eyes in both treatment groups had a dry macula at the study end point. CONCLUSIONS At 2 years, the anatomical and functional responses between the two treatment groups were similar. However, the number of given aflibercept injections was smaller in the rapid extensions protocol. TRIAL REGISTRATION EU Clinical Trials Register Number, 2015-001394-41/FI.
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Affiliation(s)
- Claudia Taipale
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland
- Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland
| | - Juha-Matti Lindholm
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland
- Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland
| | - Kai Kaarniranta
- Department of Ophthalmology, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland.
- Unit of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland.
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Sánchez-Santos I, García-Sánchez GA, Gonzalez-Salinas R, Linares-Alba MA, Rodríguez-Reyes AA, García-Santisteban R, Tirado-González V, Hernández-Piñamora E, García-Arzate D, Morales-Cantón V, Quiroz-Mercado H. Intravitreal bromfenac liposomal suspension (100 μg / 0.1 ml). A safety study in rabbit eyes. Exp Eye Res 2020; 194:108020. [PMID: 32209318 DOI: 10.1016/j.exer.2020.108020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION There is a need to find alternative treatments for MEe. Bromfenac has shown promise in inhibiting the COX-2 enzymatic pathway that partially causes the inflammatory cascade which contributes to the precipitation of ME. However, like other NSAID's, its intraocular half-life is limited. We hypothesize that a delayed-release liposome formulation containing bromfenac might provide a similar anti-inflammatory effect as long-lasting steroid release systems without the well-known steroidal side-effects. We introduced a novel formulation with these characteristics into the vitreous cavity of rabbit eyes in order to evaluate its safety profile. MATERIAL AND METHODS 10 left eyes of rabbits were injected with the liposome-encapsulated bromfenac suspension (100 μg/0.1 ml). Basal ERG's were recorded. Total follow-up time was 3 months, at which point ERG's were repeated and eyes were enucleated for histopathological study. Total amplitude and implicit times were recorded. A difference of 25% in either recording was considered significant. Significance was assessed using the paired-t test and Wilcoxon matched-pairs signed-rank test. A p-value of <0.05 was considered significant. RESULTS No significant changes were recorded in ERG measurements after 3 months when compared to basal measurements. Histopathological analysis of retinal specimens found no traces of liposome-induced toxicity. CONCLUSION The liposome-encapsulated bromfenac suspension (100 μg/0.1 ml) is not toxic and has been proven safe to use in an animal model. Therefore, this formulation shows promise as a possible future alternative treatment for ME and should be further studied to show its biological effect and efficacy.
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Affiliation(s)
- Idaira Sánchez-Santos
- Retina Department, Asociación para evitar la Ceguera en México, Hospital ''Dr. Luis Sánchez Bulnes", Vicente García Torres 46, Barrio San lucas, 04030, Coyoacán, CDMX, Mexico.
| | - Gustavo A García-Sánchez
- Santgar Laboratory, México's master formulas SA, Augusto Rodin 35, Ampliación Nápoles, 03840, CDMX, Mexico
| | - Roberto Gonzalez-Salinas
- Retina Research Department, Asociación para evitar la Ceguera en México, Hospital ''Dr. Luis Sánchez Bulnes", Vicente García Torres 46, Barrio San lucas, 04030, Coyoacán, CDMX, Mexico
| | | | - Abelardo A Rodríguez-Reyes
- Ophthalmic Pathology Service, Asociación para evitar la Ceguera en México, Hospital ''Dr. Luis Sánchez Bulnes", Vicente García Torres 46, Barrio San lucas, 04030, Coyoacán, CDMX, Mexico
| | - Rodrigo García-Santisteban
- Retina Department, Asociación para evitar la Ceguera en México, Hospital ''Dr. Luis Sánchez Bulnes", Vicente García Torres 46, Barrio San lucas, 04030, Coyoacán, CDMX, Mexico
| | - Vanessa Tirado-González
- Retina Department, Asociación para evitar la Ceguera en México, Hospital ''Dr. Luis Sánchez Bulnes", Vicente García Torres 46, Barrio San lucas, 04030, Coyoacán, CDMX, Mexico
| | - Elsa Hernández-Piñamora
- Retina Department, Asociación para evitar la Ceguera en México, Hospital ''Dr. Luis Sánchez Bulnes", Vicente García Torres 46, Barrio San lucas, 04030, Coyoacán, CDMX, Mexico
| | - Daniel García-Arzate
- Retina Department, Asociación para evitar la Ceguera en México, Hospital ''Dr. Luis Sánchez Bulnes", Vicente García Torres 46, Barrio San lucas, 04030, Coyoacán, CDMX, Mexico
| | - Virgilio Morales-Cantón
- Retina Department, Asociación para evitar la Ceguera en México, Hospital ''Dr. Luis Sánchez Bulnes", Vicente García Torres 46, Barrio San lucas, 04030, Coyoacán, CDMX, Mexico
| | - Hugo Quiroz-Mercado
- Retina Research Department, Asociación para evitar la Ceguera en México, Hospital ''Dr. Luis Sánchez Bulnes", Vicente García Torres 46, Barrio San lucas, 04030, Coyoacán, CDMX, Mexico
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11
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Lee JY, Kim JY, Lee SY, Jeong JH, Lee EK. Foveal Microvascular Structures in Eyes with Silicone Oil Tamponade for Rhegmatogenous Retinal Detachment: A Swept-source Optical Coherence Tomography Angiography Study. Sci Rep 2020; 10:2555. [PMID: 32054939 PMCID: PMC7018724 DOI: 10.1038/s41598-020-59504-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/29/2020] [Indexed: 11/08/2022] Open
Abstract
Silicone oil (SO) is widely used as a long-term intravitreal tamponading agent for rhegmatogenous retinal detachment (RRD) repair. This study investigated the structural changes of the foveal microvasculature using optical coherence tomography angiography (OCTA) in patients with RRD treated with vitrectomy and SO tamponade. Thirty-eight patients with unilateral RRD who were treated with vitrectomy and SO tamponade and were followed up for ≥3 months after SO removal were included. En face OCTA images were obtained and foveal avascular zone (FAZ) area and vascular density (VD) were compared between study eyes and unaffected contralateral eyes. The FAZ area in deep capillary plexus (DCP) was larger (P < 0.001) and the VD in DCP was lower (P = 0.022) in the study eyes than in the fellow eyes. The duration of SO tamponade was significantly correlated with the enlargement of FAZ area (P = 0.034) and reduction of VD in DCP (P = 0.015). These changes could reflect vascular insufficiency in eyes with SO tamponade and may represent a potential explanation for the pathogenesis of retinal thinning and unexplained visual loss.
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Affiliation(s)
- Jong Young Lee
- Department of Ophthalmology, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, Korea
| | - Jin Young Kim
- Department of Ophthalmology, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, Korea
| | - Sang-Yoon Lee
- Department of Ophthalmology, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, Korea
| | - Jin Ho Jeong
- Department of Ophthalmology, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, Korea
| | - Eun Kyoung Lee
- Department of Ophthalmology, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, Korea.
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
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12
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Abstract
The purpose of this meta-analysis was to evaluate the effects of lutein supplementation on macular pigment optical density (MPOD) in randomized controlled trials involving patients with age-related macular degeneration (AMD). A comprehensive search of the literature was performed in PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Wan Fang database through December 2018. Nine randomized controlled trials involving 920 eyes (855 with AMD) were included. Meta-analysis suggested that lutein supplementation (10 or 20 mg per day) was associated with an increase in MPOD (mean difference (MD) 0.07; 95% confidence interval (CI) 0.03 to 0.10), visual acuity (MD 0.28; 95%CI 0.06 to 0.50) and contrast sensitivity (MD 0.26; 95%CI 0.22 to 0.30). Stratified analyses showed the increase in MPOD to be faster and greater with higher dose and longer treatment. The available evidence suggests that dietary lutein may be beneficial to AMD patients and the higher dose could make MPOD increase in a shorter time.
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Affiliation(s)
- Liwen Feng
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
- Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Kailai Nie
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
- Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Hui Jiang
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Wei Fan
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
- * E-mail:
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13
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Hsieh YT, Alam MN, Le D, Hsiao CC, Yang CH, Chao DL, Yao X. OCT Angiography Biomarkers for Predicting Visual Outcomes after Ranibizumab Treatment for Diabetic Macular Edema. Ophthalmol Retina 2019; 3:826-834. [PMID: 31227330 PMCID: PMC6921516 DOI: 10.1016/j.oret.2019.04.027] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 04/05/2019] [Accepted: 04/26/2019] [Indexed: 04/12/2023]
Abstract
PURPOSE To correlate quantitative OCT angiography (OCTA) biomarkers with clinical features and to predict the extent of visual improvement after ranibizumab treatment for diabetic macular edema (DME) with OCTA biomarkers. DESIGN Retrospective, longitudinal study in Taiwan. PARTICIPANTS Fifty eyes of 50 patients with DME and 22 eyes of 22 healthy persons, with the exception of cataract and refractive error, from 1 hospital. METHODS Each eye underwent OCT angiography (RTVue XR Avanti System with AngioVue software version 2017.1; Optovue, Fremont, CA), and 3×3-mm2 en face OCTA images of the superficial layer and the deep layer were obtained at baseline and after 3 monthly injections of ranibizumab in the study group. OCT angiography images also were acquired from the control group. MAIN OUTCOME MEASURES Five OCTA biomarkers, including foveal avascular zone (FAZ) area (FAZ-A), FAZ contour irregularity (FAZ-CI), average vessel caliber (AVC), vessel tortuosity (VT), and vessel density (VD), were analyzed comprehensively. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) also were obtained. Student t tests were used to compare the OCTA biomarkers between the study group and the control group. Linear regression models were used to evaluate the correlations between the baseline OCTA biomarkers and the changes of BCVA and CRT after treatment. RESULTS Eyes with DME had larger AVC, VT, FAZ-A, and FAZ-CI and lower VD than those in the control group (P < 0.001 for all). After the loading ranibizumab treatment, these OCTA biomarkers improved but did not return to normal levels. Among all biomarkers, higher inner parafoveal VD in the superficial layer at baseline correlated most significantly with visual gain after treatment in the multiple regression model with adjustment for CRT and ellipsoid zone disruption (P < 0.001). To predict visual improvement, outer parafoveal VD in the superficial layer at the baseline showed the largest area under the receiver operating characteristic curve (0.787; P = 0.004). No baseline OCTA biomarkers showed any significant correlation specifically with anatomic improvement. CONCLUSIONS For eyes with DME, parafoveal VD in the superficial layer at baseline was an independent predictor for visual improvement after the loading ranibizumab treatment.
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Affiliation(s)
- Yi-Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.
| | - Minhaj Nur Alam
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois
| | - David Le
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois
| | - Chia-Chieh Hsiao
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chang-Hao Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan; School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Daniel L Chao
- Shiley Eye Institute, Department of Ophthalmology, University of California San Diego, San Diego, California
| | - Xincheng Yao
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois
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14
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Sethi HS, Das S, Naik MP, Vemparala R. BKC and CME: Is benzalkonium chloride hindering our efforts to achieve the desired postoperative visual acuity? Int Ophthalmol 2018; 39:2129-2136. [PMID: 30488176 DOI: 10.1007/s10792-018-1051-7] [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: 06/29/2018] [Accepted: 11/14/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate and compare the change in postoperative central macular thickness in patients receiving benzalkonium chloride (BKC)-preserved and BKC-free medications after uneventful phacoemulsification. SETTING V.M.M.C & Safdarjung Hospital, New Delhi (a tertiary health care hospital). STUDY DESIGN Prospective randomized comparative observational study. MATERIALS AND METHODS Once patients were selected, the baseline standard ophthalmic examination was done. SAMPLE SIZE 140 eyes were enrolled and randomly divided into two groups. (a) Group I: receive BKC-preserved topical medications and (b) Group II: receive BKC-free topical medications of same constituents postoperatively. Group I patients received topical BKC-preserved moxifloxacin 0.5% + dexamethasone 0.1% eye drops six times a day, timolol maleate 0.5% twice daily, tropicamide 0.8% + phenylephrine 5% once a day for 6 weeks, and Group II received same BKC-free topical eye drops for 6 weeks. Postoperatively, the patients were reviewed at day 1, week 1, week 6 for same parameters. STATISTICS Quantitative variables: paired and unpaired t test. p value < 0.05 was considered statistically significant. RESULTS The mean CMT in μm at 1 week in Group I was 269.39 ± 14.56 and in Group II was 270.04 ± 6.56. The mean CMT in µm at 6 weeks in Group I was 270.39 ± 17.18 and in Group II was 270.90 ± 7.00. CONCLUSION Neither do BKC-preserved topical medications have any independent role in increasing the central macular thickness after uneventful surgery nor do they have any role in causing pseudophakic CME.
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Affiliation(s)
- Harinder Singh Sethi
- Department of Ophthalmology, V.M.M.C & Safdarjung Hospital, Room No. 430 of Eye OPD, 4th Floor of OPD Building, Ansari Nagar, Ring Road, New Delhi, 110029, India
| | - Sugourab Das
- Department of Ophthalmology, V.M.M.C & Safdarjung Hospital, Room No. 430 of Eye OPD, 4th Floor of OPD Building, Ansari Nagar, Ring Road, New Delhi, 110029, India
| | - Mayuresh P Naik
- Department of Ophthalmology, V.M.M.C & Safdarjung Hospital, Room No. 430 of Eye OPD, 4th Floor of OPD Building, Ansari Nagar, Ring Road, New Delhi, 110029, India.
| | - Rajshekhar Vemparala
- Department of Ophthalmology, V.M.M.C & Safdarjung Hospital, Room No. 430 of Eye OPD, 4th Floor of OPD Building, Ansari Nagar, Ring Road, New Delhi, 110029, India
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Malik TG, Ahmed SS, Gul R, Khalil M, Malik AA, Khan M. Effect of intravitreal bevacizumab on macular thickness: exploring serum and vitreous
proangiogenic biomarkers in patients with diabetic macular edema. Turk J Med Sci 2018; 48:833-839. [PMID: 30119160 DOI: 10.3906/sag-1802-212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background/aim This study evaluates diabetic macular-edema (DME) patients for the effect of intravitreal bevacizumab (IVB)
injection on macular thickness and proangiogenic biomarkers in serum and vitreous. Materials and methods Forty DME patients were analyzed for macular thickness (MT). Twelve proangiogenic biomarkers in serum
and vitreous were analyzed before and after IVB. Results Significant decrease in MT with vitreal vascular endothelial growth factor-A (VEGF-A) was observed as expected after IVB,
while serum VEGF-A did not follow a decreasing trend in contrast to VEGF-C, which decreased both in serum and vitreous. Other
vitreal factors like bone morphogenetic protein-9 (BMP9) and fibroblast growth factor (FGF) were also significantly decreased, while
endothelial growth factor (EGF) increased following IVB. Before IVB, significant negative correlations were vitreous BMP9 with serum
FGF, vitreous human growth factor (HGF) and interleukin-8 (IL-8) with serum endothelin, and vitreous and serum FGF and serum
placental growth factor (PLGF) with EGF. After IVB, negative correlations in serum vs. vitreous were found for both HGF and PLGF
with BMP9, and angiopoietin with FGF. Cube average thickness was negatively correlated with serum FGF and positively correlated
with vitreous PLGF and endothelin. Conclusion Vascular endothelial growth factors are not the only factors that cause macular edema in diabetic patients. The effect of IVB
on different proangiogenic biomarkers indicated a complex interplay of other factors in DME.
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Nakano E, Ota T, Jingami Y, Nakata I, Hayashi H, Yamashiro K. Disorganization of the Retinal Inner Layers after Anti-VEGF Treatment for Macular Edema due to Branch Retinal Vein Occlusion. Ophthalmologica 2018; 240:229-234. [PMID: 30089307 DOI: 10.1159/000490809] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 06/12/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the association between disorganization of the retinal inner layers (DRIL) and visual acuity (VA) after anti-VEGF treatment for macular edema (ME) due to branch retinal vein occlusion (BRVO). METHODS Sixty eyes of 60 patients were retrospectively investigated. Baseline characteristics and factors analyzed on optical coherence tomography (OCT) examination at the final visit were evaluated in association with VA at the final visit. RESULTS DRIL was detected in 39 eyes at the final visit. The central subfield thickness was significantly higher in the eyes with DRIL. While DRIL length at the final visit showed a significant association with final VA on univariable analysis, only age and ellipsoid zone disruption on OCT at the final visit were found to be significantly associated with VA on multivariable analysis. CONCLUSIONS DRIL had only a minor role in determining VA after anti-VEGF treatment for ME due to BRVO.
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Mehta H, Hennings C, Gillies MC, Nguyen V, Campain A, Fraser‐Bell S. Anti-vascular endothelial growth factor combined with intravitreal steroids for diabetic macular oedema. Cochrane Database Syst Rev 2018; 4:CD011599. [PMID: 29669176 PMCID: PMC6494419 DOI: 10.1002/14651858.cd011599.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND The combination of steroid and anti-vascular endothelial growth factor (VEGF) intravitreal therapeutic agents could potentially have synergistic effects for treating diabetic macular oedema (DMO). On the one hand, if combined treatment is more effective than monotherapy, there would be significant implications for improving patient outcomes. Conversely, if there is no added benefit of combination therapy, then people could be potentially exposed to unnecessary local or systemic side effects. OBJECTIVES To assess the effects of intravitreal agents that block vascular endothelial growth factor activity (anti-VEGF agents) plus intravitreal steroids versus monotherapy with macular laser, intravitreal steroids or intravitreal anti-VEGF agents for managing DMO. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2018, Issue 1); Ovid MEDLINE; Ovid Embase; LILACS; the ISRCTN registry; ClinicalTrials.gov and the ICTRP. The date of the search was 21 February 2018. SELECTION CRITERIA We included randomised controlled trials (RCTs) of intravitreal anti-VEGF combined with intravitreal steroids versus intravitreal anti-VEGF alone, intravitreal steroids alone or macular laser alone for managing DMO. We included people with DMO of all ages and both sexes. We also included trials where both eyes from one participant received different treatments. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane.Two authors independently reviewed all the titles and abstracts identified from the electronic and manual searches against the inclusion criteria. Our primary outcome was change in best corrected visual acuity (BCVA) between baseline and one year. Secondary outcomes included change in central macular thickness (CMT), economic data and quality of life. We considered adverse effects including intraocular inflammation, raised intraocular pressure (IOP) and development of cataract. MAIN RESULTS There were eight RCTs (703 participants, 817 eyes) that met our inclusion criteria with only three studies reporting outcomes at one year. The studies took place in Iran (3), USA (2), Brazil (1), Czech Republic (1) and South Korea (1). Seven studies used the unlicensed anti-VEGF agent bevacizumab and one study used licensed ranibizumab. The study that used licensed ranibizumab had a unique design compared with the other studies in that included eyes had persisting DMO after anti-VEGF monotherapy and received three monthly doses of ranibizumab prior to allocation. The anti-VEGF agent was combined with intravitreal triamcinolone in six studies and with an intravitreal dexamethasone implant in two studies. The comparator group was anti-VEGF alone in all studies; two studies had an additional steroid monotherapy arm, another study had an additional macular laser photocoagulation arm. Whilst we judged these studies to be at low risk of bias for most domains, at least one domain was at unclear risk in all studies.When comparing anti-VEGF/steroid with anti-VEGF monotherapy as primary therapy for DMO, we found no meaningful clinical difference in change in BCVA (mean difference (MD) -2.29 visual acuity (VA) letters, 95% confidence interval (CI) -6.03 to 1.45; 3 RCTs; 188 eyes; low-certainty evidence) or change in CMT (MD 0.20 μm, 95% CI -37.14 to 37.53; 3 RCTs; 188 eyes; low-certainty evidence) at one year. There was very low-certainty evidence on intraocular inflammation from 8 studies, with one event in the anti-VEGF/steroid group (313 eyes) and two events in the anti-VEGF group (322 eyes). There was a greater risk of raised IOP (Peto odds ratio (OR) 8.13, 95% CI 4.67 to 14.16; 635 eyes; 8 RCTs; moderate-certainty evidence) and development of cataract (Peto OR 7.49, 95% CI 2.87 to 19.60; 635 eyes; 8 RCTs; moderate-certainty evidence) in eyes receiving anti-VEGF/steroid compared with anti-VEGF monotherapy. There was low-certainty evidence from one study of an increased risk of systemic adverse events in the anti-VEGF/steroid group compared with the anti-VEGF alone group (Peto OR 1.32, 95% CI 0.61 to 2.86; 103 eyes).One study compared anti-VEGF/steroid versus macular laser therapy. At one year investigators did not report a meaningful difference between the groups in change in BCVA (MD 4.00 VA letters 95% CI -2.70 to 10.70; 80 eyes; low-certainty evidence) or change in CMT (MD -16.00 μm, 95% CI -68.93 to 36.93; 80 eyes; low-certainty evidence). There was very low-certainty evidence suggesting an increased risk of cataract in the anti-VEGF/steroid group compared with the macular laser group (Peto OR 4.58, 95% 0.99 to 21.10, 100 eyes) and an increased risk of elevated IOP in the anti-VEGF/steroid group compared with the macular laser group (Peto OR 9.49, 95% CI 2.86 to 31.51; 100 eyes).One study provided very low-certainty evidence comparing anti-VEGF/steroid versus steroid monotherapy at one year. There was no evidence of a meaningful difference in BCVA between treatments at one year (MD 0 VA letters, 95% CI -6.1 to 6.1, low-certainty evidence). Likewise, there was no meaningful difference in the mean CMT at one year (MD - 9 μm, 95% CI -39.87μm to 21.87μm between the anti-VEGF/steroid group and the steroid group. There was very low-certainty evidence on raised IOP at one year comparing the anti-VEGF/steroid versus steroid groups (Peto OR 0.75, 95% CI 0.16 to 3.55).No included study reported impact of treatment on patients' quality of life or economic data. None of the studies reported any cases of endophthalmitis. AUTHORS' CONCLUSIONS Combination of intravitreal anti-VEGF plus intravitreal steroids does not appear to offer additional visual benefit compared with monotherapy for DMO; at present the evidence for this is of low-certainty. There was an increased rate of cataract development and raised intraocular pressure in eyes treated with anti-VEGF plus steroid versus anti-VEGF alone. Patients were exposed to potential side effects of both these agents without reported additional benefit. The majority of the evidence comes from studies of bevacizumab and triamcinolone used as primary therapy for DMO. There is limited evidence from studies using licensed intravitreal anti-VEGF agents plus licensed intravitreal steroid implants with at least one year follow-up. It is not known whether treatment response is different in eyes that are phakic and pseudophakic at baseline.
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Affiliation(s)
- Hemal Mehta
- Royal Free London NHS Foundation TrustLondonUK
- University of SydneyMacular Research Group, Save Sight InstituteSydneyAustralia
| | | | - Mark C Gillies
- University of SydneyMacular Research Group, Save Sight InstituteSydneyAustralia
| | - Vuong Nguyen
- University of SydneyMacular Research Group, Save Sight InstituteSydneyAustralia
| | - Anna Campain
- University of SydneyMacular Research Group, Save Sight InstituteSydneyAustralia
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Lim IL, Loo AVP, Subrayan V, Khang TF, See MH, Alip A, Taib NAM. Dosage-dependent reduction of macular pigment optical density in female breast cancer patients receiving tamoxifen adjuvant therapy. Breast 2018; 39:117-122. [PMID: 29660599 DOI: 10.1016/j.breast.2018.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 10/31/2017] [Revised: 03/30/2018] [Accepted: 04/03/2018] [Indexed: 11/19/2022] Open
Abstract
It is now increasingly common for breast cancer patients to receive adjuvant tamoxifen therapy for a period of up to 10 years. As survival rate increases, managing tamoxifen ocular toxicities is important for patients' quality of life. Macular pigments in photoreceptor cells protect against free radical damage, which can cause macular degeneration. By reducing macular pigment concentration, tamoxifen may increase the risk of macular degeneration. Here, we compared macular pigment optical density (MPOD) and central macular thickness between breast cancer patients on tamoxifen adjuvant therapy (n = 70), and a control group (n = 72). Multiple regression analysis indicated that MPOD decreases with increasing tamoxifen dosage, up to a threshold of about 20 g, after which MPOD plateaus out. Mean MPOD in the treatment group (mean = 0.40) was significantly lower (p-value = 0.02) compared to the control group (mean = 0.47) for the left eye, and for the right eye (treatment mean = 0.39; control mean = 0.48; p-value = 0.009). No significant difference in mean central macular thickness was found between the treatment and the control group (p-values > 0.4). In the control group, MPOD and central macular thickness showed significant correlation (r∼0.30; p-values < 0.01) for both eyes. However, in the treatment group, loss of significant correlation was observed in the left eye (r = 0.21; p-value = 0.08). The present results show that MPOD decreases non-linearly as a function of tamoxifen dosage, and highlight the potential of tamoxifen to reduce macular pigment concentration through an unknown mechanism that does not depend on macular thinning solely.
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Affiliation(s)
- I-Liang Lim
- Department of Ophthalmology, University of Malaya Medical Centre, Lembah Pantai, 59100, Kuala Lumpur, Malaysia.
| | - Angela Voon Pei Loo
- Department of Ophthalmology, University of Malaya Medical Centre, Lembah Pantai, 59100, Kuala Lumpur, Malaysia
| | - Visvaraja Subrayan
- Department of Ophthalmology, University of Malaya Medical Centre, Lembah Pantai, 59100, Kuala Lumpur, Malaysia.
| | - Tsung Fei Khang
- Institute of Mathematical Sciences, Faculty of Science, University of Malaya, 50603, Kuala Lumpur, Malaysia; University of Malaya Centre for Data Analytics, Faculty of Science, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Mee Hoong See
- Department of Surgery, University of Malaya Medical Centre, Lembah Pantai, 59100, Kuala Lumpur, Malaysia
| | - Adlinda Alip
- Department of Oncology, University of Malaya Medical Centre, Lembah Pantai, 59100, Kuala Lumpur, Malaysia
| | - Nur Aishah Mohd Taib
- Department of Surgery, University of Malaya Medical Centre, Lembah Pantai, 59100, Kuala Lumpur, Malaysia
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Abstract
PURPOSE To describe the incidence and features of acute exudative maculopathy (AEM) after half-fluence photodynamic therapy (PDT) and/or very minimal fluence PDT. METHODS Retrospective chart review of all patients treated over a 7-year period. RESULTS A total of 52 patients (58 eyes, 140 treatments) were treated with half-fluence PDT and/or very minimal fluence PDT. Patients were diagnosed with either central serous chorioretinopathy (CSCR) or neovascular age-related macular degeneration (nAMD). Two patients (1 CSCR and 1 nAMD) returned to the clinic with acute vision loss after treatment and were identified as having developed AEM. In the CSCR case, resolution occurred after intravitreal bevacizumab treatment. The nAMD case resolved with topical difluprednate treatment. We were unable to identify any risk factors for the development of AEM. CONCLUSION AEM seems to be a rare (incidence 1.4% per treatment) and unpredictable reaction related to the proinflammatory effects of half-fluence PDT and very minimal fluence PDT. Because of the inherent limitations of this study, the true incidence of AEM after reduced-fluence PDT may be higher.
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Affiliation(s)
- Zaid Mammo
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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Lin HY, Lee CY, Huang JY, Yang SF, Chao SC. Concurrent injection of dexamethasone intravitreal implant and anti-angiogenic agent in patients with macular edema: A retrospective cohort study. Medicine (Baltimore) 2017; 96:e8868. [PMID: 29382007 PMCID: PMC5709006 DOI: 10.1097/md.0000000000008868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 11/25/2022] Open
Abstract
To evaluate the safety and efficiency in macular edema patients who concurrently received a single injection of a dexamethasone intravitreal implant (DEX, 0.7 mg) and ranibizumab (2.3 mg).A retrospective cohort study was conducted, and medical records from 2012 to 2016 were reviewed. Patients who received concurrent DEX and ranibizumab injections with a follow-up period of at least 3 months were enrolled in the study group. An age and gender-matched group received ranibizumab injections and was designated the control group. The best-corrected visual acuity (BCVA), central macular thickness (CMT) and intraocular pressure (IOP) were included in the analysis. Steroid-induced ocular hypertension (SIOH) is defined as either an elevation of more than 10 mmHg from baseline or a single IOP measurement of more than 30 mmHg.A total of 26 patients were enrolled in the current study with 13 patients in each group. Both the BCVA (P = .04) and CMT (P < .01) achieved significant improvement after the follow-up period in the study group. The IOP increased after the injection but no significant elevation was observed throughout the follow-up period in the study group (P = .15). For SIOH, 1 patient in the study group had an elevated IOP of 10 mmHg (7.7%) at 2 postoperative months, and no single IOP measurement of more than 30 mmHg was obtained. Five patients (38.5%) in the study group received medical treatment that successfully retarded their IOP elevation, and no individuals required surgical management. In the control group, there were no significant fluctuations concerning BCVA, CMT, and IOP, and no ocular hypertension was observed. According to the inter-group analysis, the CMT and BCVA recovered more significantly in the study group than in the control group.Concurrent injection of DEX and ranibizumab is a preliminary method that shows effectiveness in treating ME. Furthermore, safety is also guaranteed, with moderate levels of severity and transient IOP elevation being observed. A future large-scale study is necessary to evaluate the long-term effects and safety of this combined treatment.
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Affiliation(s)
- Hung-Yu Lin
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua
- Institute of Medicine
- Department of Optometry, Chung Shan Medical University, Taichung
- Department of Optometry, Yuanpei University of Medical Technology, Hsinchu
| | - Chia-Yi Lee
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua
| | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung
| | - Shun-Fa Yang
- Institute of Medicine
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung
| | - Shih-Chun Chao
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua
- Department of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu
- Department of Optometry, Central Taiwan University of Science and Technology, Taichung, Taiwan
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Jackson TL, Regillo CD, Girach A, Dugel PU. Baseline Predictors of Vitreomacular Adhesion/Traction Resolution Following an Intravitreal Injection of Ocriplasmin. Ophthalmic Surg Lasers Imaging Retina 2017; 47:716-23. [PMID: 27548448 DOI: 10.3928/23258160-20160808-04] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 06/07/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND OBJECTIVE To determine factors predicting response to ocriplasmin (Jetrea; ThromboGenics, Iselin, NJ) response in patients with symptomatic vitreomacular adhesion (VMA). PATIENTS AND METHODS Combined analysis of two multicenter, prospective, randomized, double-masked trials of intravitreal ocriplasmin 125 µg injection versus placebo. Patients had vitreomacular traction with or without a full-thickness macular hole (FTMH). Multivariate logistic regression was used to determine factors influencing treatment response (complete VMA release [day 28] and non-surgical FTMH closure [month 6]). RESULTS Younger age, presence of FTMH (odds ratio [OR] = 2.1; 95% confidence interval [CI], 1.1-3.7), VMA diameter of 1,500 µm or less (OR = 4.9; 95% CI, 2.0-12.4), phakic lens status (OR = 2.8; 95% CI, 1.5-5.2), and absence of epiretinal membrane (OR = 4.1; 95% CI, 2.2-7.9) predicted VMA resolution. FTMHs with apical diameter of 250 µm or less were more likely to close than larger holes (58.3% vs. 24.6%; P = .013). Both FTMH size groups had significantly greater chance of VMA resolution and FTMH closure versus controls. CONCLUSION Ocriplasmin is most effective in younger patients with focal VMA and without an epiretinal membrane. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:716-723.].
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Shiraya T, Kato S, Araki F, Ueta T, Miyaji T, Yamaguchi T. Aqueous cytokine levels are associated with reduced macular thickness after intravitreal ranibizumab for diabetic macular edema. PLoS One 2017; 12:e0174340. [PMID: 28346545 PMCID: PMC5367773 DOI: 10.1371/journal.pone.0174340] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 03/07/2017] [Indexed: 12/25/2022] Open
Abstract
Purpose It is controversial whether the administration of anti-vascular endothelial growth factor drugs for diabetic macular edema (DME) affects intraocular inflammatory cytokines. In this study, we measured cytokine concentration in aqueous humor before and after intravitreal injection of ranibizumab (IVR). The aim was to determine changes in cytokine concentration and their effects on DME reduction. Methods Twelve patients (13 eyes) with DME received two IVR (0.5 mg) with a 1 month interval, and a total of 26 aqueous humor samples were obtained. Macular thickness was measured with an optical coherence tomography (OCT) using thickness-map mode with an Early Treatment Diabetic Retinopathy Study (ETDRS) 9-zone grid that was divided into two zones: a central circle with a diameter of 1 mm (zone1); and an outer circle with a diameter of 6 mm (zone2). Results The concentration of eotaxin-1 in aqueous humor samples decreased significantly after IVR. Baseline cytokine concentration was associated with IVR-induced DME reduction. In zone1, higher baseline concentration of interferon-induced protein (IP)-10, and in zone 2, higher baseline concentration of granulocyte-macrophage colony-stimulating factor, IP-10, and tumor necrosis factor (TNF) α; and lower baseline concentration of eotaxin-1, interleukin (IL)-5, and IL-8 were associated with improved DME. Cytokine changes were associated with IVR-induced DME reduction. In zone1, lower concentration of IP-10 compared to baseline or higher concentration of macrophage inflammatory protein (MIP) -α, and in zone 2, lower concentration of IL-5 compared to baseline, IL-8, and IP-10 or higher concentration of eotaxin-1 and MIP-1β were associated with improved DME. Conclusions These findings suggest that ranibizumab affects the concentration of cytokines in aqueous humor. Various cytokines contribute to a decrease in retinal thickness, both in the center of the macula and in a larger area of the retina.
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Affiliation(s)
- Tomoyasu Shiraya
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- * E-mail:
| | - Satoshi Kato
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Fumiyuki Araki
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Ueta
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tempei Miyaji
- Department of Clinical Trial Data Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takuhiro Yamaguchi
- Department of Clinical Trial Data Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
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23
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Veselovskaya NN. [CHANGES OF LIFETIME MORPHOLOGICAL PARAMETERS OF THE RETINA ON THE BACKGROUND OF CORRECTION OF LIPID METABOLISM IN PATIENTSWITH TYPE 2 DIABETES MELLITUS]. ACTA ACUST UNITED AC 2017; 63:91-94. [PMID: 29975833 DOI: 10.15407/fz63.01.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The functional changes of retina morphological parameters of macular zone were investigated under condition of long term action of fenofibrate, 145 mg in patients with diabetes mellitus type 2. Dynamic observation of certain ophthalmologic (visual acuity, macular thickness zone) and system functional parameters (lipid fractions content in serum) in long-term use of this medical drug in 20 patients with diabetes type 2 and DMO for 8 months. In this period we revealed some positive changes in the functional state of the macular area: increase of visual acuity, decrease of macula thickness and the improvement of the lipid profile in blood serum.
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Dugel PU, Tolentino M, Feiner L, Kozma P, Leroy A. Results of the 2-Year Ocriplasmin for Treatment for Symptomatic Vitreomacular Adhesion Including Macular Hole (OASIS) Randomized Trial. Ophthalmology 2016; 123:2232-47. [PMID: 27499517 DOI: 10.1016/j.ophtha.2016.06.043] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/31/2016] [Accepted: 06/13/2016] [Indexed: 02/02/2023] Open
Abstract
PURPOSE The Ocriplasmin for Treatment for Symptomatic Vitreomacular Adhesion Including Macular Hole (OASIS) trial was designed to evaluate the long-term efficacy and safety profile of ocriplasmin for the treatment of symptomatic vitreomacular adhesion (VMA)/vitreomacular traction, including full-thickness macular hole (FTMH). DESIGN Phase 3b, randomized, sham-controlled, double-masked, multicenter clinical trial. PARTICIPANTS Sample size was 220 subjects (146 ocriplasmin, 74 sham) randomized in a 2:1 ratio to receive intravitreal ocriplasmin 0.125 mg or sham injection. METHODS The trial involved 12 visits over 24-months. Inclusion criteria included presence of VMA and best-corrected visual acuity (BCVA) of 20/32 or worse in the study eye. Exclusion criteria included FTMH >400 μm, presence of epiretinal membrane (ERM), and aphakia in the study eye. MAIN OUTCOME MEASURES The primary efficacy end point was the proportion of subjects with pharmacologic VMA resolution at day 28. Secondary efficacy end points were assessed at month 24 and included proportion of subjects with BCVA gain from baseline, nonsurgical FTMH closure, vitrectomy, and Visual Function Questionnaire 25 (VFQ-25) outcomes. RESULTS The OASIS trial met its primary end point with pharmacologic VMA resolution at day 28 being significantly higher in the ocriplasmin group (41.7%) compared with the sham group (6.2%). The treatment effect was maintained until study end. In the ocriplasmin group, pharmacologic VMA resolution at day 28 was higher in subgroups with the following baseline characteristics compared with the complementary subgroups without them: presence of focal VMA, presence of FTMH, absence of ERM, and phakic lens status. In the ocriplasmin group, 50.5% of subjects had a ≥2-line improvement in BCVA from baseline compared with 39.1% of subjects in the sham group. The nonsurgical FTMH closure rate was 30.0% for the ocriplasmin group compared with 15.4% for the sham group. All other secondary end points also favored ocriplasmin over sham. Regarding safety, most adverse events were mild to moderate, had a short onset time, and were transient, with no new safety signals identified. CONCLUSIONS The OASIS trial demonstrates the long-term efficacy and safety of ocriplasmin, providing improved resolution of symptomatic VMA compared with previous phase 3 trials with no additional safety signals identified.
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Affiliation(s)
- Pravin U Dugel
- Retina Consultants of Arizona, Phoenix, Arizona; USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California.
| | - Michael Tolentino
- Center for Retina and Macular Disease, Winter Haven, Florida; University of Central Florida, Orlando, Florida
| | - Leonard Feiner
- Hackensack University Medical Center, Hackensack, New Jersey; NJ Retina, Ridgewood, New Jersey
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Ma L, Liu R, Du JH, Liu T, Wu SS, Liu XH. Lutein, Zeaxanthin and Meso-zeaxanthin Supplementation Associated with Macular Pigment Optical Density. Nutrients 2016; 8:nu8070426. [PMID: 27420092 PMCID: PMC4963902 DOI: 10.3390/nu8070426] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [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: 06/19/2016] [Revised: 07/02/2016] [Accepted: 07/06/2016] [Indexed: 01/16/2023] Open
Abstract
The purpose of this study was to evaluate the effects of lutein, zeaxanthin and meso-zeaxanthin on macular pigment optical density (MPOD) in randomized controlled trials (RCTs) among patients with age-related macular degeneration (AMD) and healthy subjects. Medline, Embase, Web of Science and Cochrane Library databases was searched through May 2016. Meta-analysis was conducted to obtain adjusted weighted mean differences (WMD) for intervention-versus-placebo group about the change of MPOD between baseline and terminal point. Pearson correlation analysis was used to determine the relationship between the changes in MPOD and blood xanthophyll carotenoids or baseline MPOD levels. Twenty RCTs involving 938 AMD patients and 826 healthy subjects were identified. Xanthophyll carotenoids supplementation was associated with significant increase in MPOD in AMD patients (WMD, 0.07; 95% CI, 0.03 to 0.11) and healthy subjects (WMD, 0.09; 95% CI, 0.05 to 0.14). Stratified analysis showed a greater increase in MPOD among trials supplemented and combined with meso-zeaxanthin. Additionally, the changes in MPOD were related with baseline MPOD levels (rAMD = −0.43, p = 0.06; rhealthy subjects = −0.71, p < 0.001) and blood xanthophyll carotenoids concentration (rAMD = 0.40, p = 0.07; rhealthy subjects = 0.33, p = 0.05). This meta-analysis revealed that lutein, zeaxanthin and meso-zeaxanthin supplementation improved MPOD both in AMD patients and healthy subjects with a dose-response relationship.
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Affiliation(s)
- Le Ma
- The First Affiliated Hospital, Xi'an Jiaotong University College of Medicine, 277 Yanta West Road, Xi'an 710061, Shaanxi, China.
- School of Public Health, Xi'an Jiaotong University Health Science Center, 76 Yanta West Road, Xi'an 710061, Shaanxi, China.
| | - Rong Liu
- School of Public Health, Xi'an Jiaotong University Health Science Center, 76 Yanta West Road, Xi'an 710061, Shaanxi, China.
- The 3201 Hospital, Xi'an Jiao tong University College of Medicine, 783 Tianhan Road, Hanzhong 723000, Shaanxi, China.
| | - Jun Hui Du
- The Ninth Hospital of Xi'an, Xi'an Jiaotong University College of Medicine, 151 East of South Second Ring Road, Xi'an 710054, Shaanxi, China.
| | - Tao Liu
- The 3201 Hospital, Xi'an Jiao tong University College of Medicine, 783 Tianhan Road, Hanzhong 723000, Shaanxi, China.
| | - Shan Shan Wu
- National Clinical Research Center of Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, 95 Yongan Road, Beijing 100050, China.
| | - Xiao Hong Liu
- The First Affiliated Hospital, Xi'an Jiaotong University College of Medicine, 277 Yanta West Road, Xi'an 710061, Shaanxi, China.
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Zielińska E, Rokicki D, Wielgórski M, Szaflik J, Szaflik JP. [Effect of 0.1% diclofenac ophthalmic solution on inflammatory response and macular thickness following phacoemulsification cataract surgery]. Klin Oczna 2016; 118:270-277. [PMID: 29911358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE To evaluate 0.1% diclofenac sodium as an adjunctive therapy with loteprednol etabonate on postoperative inflammation in the anterior chamber and on foveal and parafoveal retinal thickness. MATERIAL AND METHODS Eighty eyes eligible for phacoemulsification were enrolled in a randomized clinical trial. Patients in group I (N = 40) received anti-inflammatory treatment consisting of 0.1% diclofenac with 0.5% loteprednol; group II (N = 40) patients received 0.5% loteprednol alone. Best corrected visual acuity and intraocular pressure were measured, and laser flarephotometry was done. Foveal and parafoveal thickness were assessed by optical coherence tomography. Results: Median flare values decreased more rapidly in group I at 7 and 14 days (7.9 and 7.4 ph/ms, respectively) than in group II (13.7 and 11.8 ph/ms, respectively; p < 0.0001). Group II had significantly increased parafoveal thickness at 14 and 42 days (median 285.59 μm, p = 0.001 and 288.38 μm, p < 0.001, respectively). Parafoveal thickness differed significantly between groups at 14 and 42 days (p = 0.0085, p = 0.0004, respectively). CONCLUSIONS Eyes treated with both diclofenac sodium and loteprednol etabonate showed less inflammatory response and were less likely to develop foveal and parafoveal thickening than those treated with steroid only.
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Yan Y, Wang T, Cao J, Wang M, Li F. Clinical research on intravitreal injection of bevacizumab in the treatment of macula lutea and retinal edema of ocular fundus disease. Pak J Pharm Sci 2015; 28:1481-1484. [PMID: 26431660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This paper aimed to explore clinically curative effect of intravitreal injection of bevacizumab in the treatment of macula lutea and retinal edema of ocular fundus disease. The number of 300 patients (390 eyes) with ocular fundus diseases including retinal vein occlusion (RVO), diabetic retinopathy (DR), age-related macular degeneration (ARMD), central serous chorioretinopathy (CSC), choridal new vessel (CNV) received and cured in the hospital from February 2010 to February 2014 were given intravitreal injection of bevacizumab (1.5mg) with once per month and a total of 2-3 times. Results of patients' vision and fluorescence fundus angiography (FFA), optical coherence tomography (OCT) before and after treatment were compared and curative effects were evaluated. Vision of 349 eyes (89.49%) improved obviously with the average of more than 2 lines, patient's intraocular pressure (IOP) was normal and all indexes were clearly better; vision of 26 eyes (6.67%) was stable before the treatment and without any changes after the treatment, the situation of fundus got better without increased IOP; vision of 15 eyes (3.85%) decreased to some extent, and the symptoms eased slightly after symptomatic treatment. In the 1st day after intravitreal injection, best-corrected visual acuity increased to 0.239±0.175, best-corrected visual acuity in 1 m was 0.315±0.182, in 3m continuously climbed to 0.350±0.270, and in 6 m was 0.362±0.282. Compared with vision before injection, t value was t=3.184, t=7.213, t=9.274 and t=9.970 (P=0.002, P=0.000, P=0.000 and P=0.000) respectively, and all P were less than 0.01. Furthermore, the difference was significant if a=0.01, which could confirm that 1m best corrected visual acuity of patients after intravitreal injection improved clearly in combination with before injection and 3m and 6 m visions enhanced constantly after injection. To sum up, intravitreal injection of bevacizumab in treating ocular fundus disease improves patient's vision effectively, also relieves macula lutea, retinal edema and other symptoms obviously, and promotes the hemorrhage absorption of vitreous body and retina.
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Affiliation(s)
- Ying Yan
- Ophthalmology, Linyi People's Hospital, Shandong, China
| | - Tao Wang
- Ophthalmology, Linyi People's Hospital, Shandong, China
| | - Jing Cao
- Department of pharmacy, Linyi People's Hospital, Shandong, China
| | - Meng Wang
- Department of pharmacy, Linyi People's Hospital, Shandong, China
| | - Fenghua Li
- Ophthalmology, Linyi People's Hospital, Shandong, China
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Turan-Vural E, Halili E, Serin D. Assessing the effects of ketorolac and acetazolamide on macular thickness by optical coherence tomography following cataract surgery. Int Ophthalmol 2015; 34:525-31. [PMID: 24022643 DOI: 10.1007/s10792-013-9847-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 08/14/2013] [Indexed: 11/28/2022]
Abstract
We aimed to evaluate the efficacy of topical ketorolac 0.5 % solution and oral acetazolamide 250 mg/day delivery during the first month after uneventful phacoemulsification surgery by measuring the macular thickness using optical coherence tomography. Our nonmasked randomized prospective study comprised 87 eyes of 80 patients. Complete follow-up was achieved on 84 eyes of 77 eligible patients. Postoperatively, the patients were divided into three groups. One group received ketorolac 0.5 %, the other group received acetazolamide 250 mg/day, and the control group was given no agent. Macular thickness and volume were measured at 1 week and 1 month after surgery by optical coherence tomography. Foveal thickness, parafoveal thickness, and perifoveal thickness were determined to be significantly elevated at postoperative 1 week and 1 month in the control group. Foveal, perifoveal, and parafoveal volumes were also significantly high at postoperative week 1 and month 1 in the control group. There was no significant difference between the ketorolac and acetazolamide groups. The correlation analysis between best-corrected visual acuity, and volume and thickness revealed a negative correlation in the acetazolamide group. Use of acetazolamide after cataract surgery is as effective as ketorolac on macular thickness and volume.
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Miniewicz J, Kubicka-Trząska A, Karska-Basta I, Romanowska-Dixon B. [Managment of subretinal heamorrhages within the macular area using intravitreal injections of recombined tissue plasminogen activator, sulphur hexafluoride and ranihizumab--preliminary report]. Klin Oczna 2015; 117:165-168. [PMID: 26999939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Submacular hemorrhages cause serious vision impairment. Patient observation, waiting for the spontaneous blood reabsorption and resolution of the haemorrhage leads to the severe damage to retinal tissue as a result of scar formation. The paper presents 7 cases of patients with submacular haemorrhages treated with intravitreal injections of recombined tissue plasminogen activator (rtPA) and sulphur hexafluoride (SFG). In 4 cases, the haemorrhage was secondary to AMD, in two cases to trauma, and it was idiopathic in one case. All patients were treated with intravitreal injections of rtPA and SF6 for thrombolysis and pneumatic displacement of haemorrhage outside macular structures. Ranibizumab was additionally administered to patients with age-related macular degeneration. Such treatment improved visual acuity in all patients, reducing the central retinal thickness as shown in follow-up optical coherence tomography. The presented treatment of submacular hemorrhages with intravitreal injections of rtPA and SF6 provided good results, but in order to develop a standard management algorithm for this disease, the analysis of larger patient sample is required.
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30
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Bovier ER, Hammond BR. A randomized placebo-controlled study on the effects of lutein and zeaxanthin on visual processing speed in young healthy subjects. Arch Biochem Biophys 2014; 572:54-57. [PMID: 25483230 DOI: 10.1016/j.abb.2014.11.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [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: 09/11/2014] [Revised: 11/14/2014] [Accepted: 11/22/2014] [Indexed: 11/18/2022]
Abstract
Speed of processing is a particularly important characteristic of the visual system. Often a behavioral reaction to a visual stimulus must be faster than the conscious perception of that stimulus, as is the case with many sports (e.g., baseball). Visual psychophysics provides a relatively simple and precise means of measuring visual processing speed called the temporal contrast sensitivity function (tCSF). Past study has shown that macular pigment (a collection of xanthophylls, lutein (L), meso-zeaxanthin (MZ) and zeaxanthin (Z), found in the retina) optical density (MPOD) is positively correlated with the tCSF. In this study, we found similar correlations when testing 102 young healthy subjects. As a follow-up, we randomized 69 subjects to receive a placebo (n=15) or one of two L and Z supplements (n=54). MPOD and tCSF were measured psychophysically at baseline and 4months. Neither MPOD nor tCSF changed for the placebo condition, but both improved significantly as a result of supplementation. These results show that an intervention with L and Z can increase processing speed even in young healthy subjects.
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Affiliation(s)
- Emily R Bovier
- Department of Psychology, SUNY Oswego, Oswego, NY 13126, USA; Brain and Behavioral Sciences, The University of Georgia, Athens, GA 30602-3013, USA
| | - Billy R Hammond
- Brain and Behavioral Sciences, The University of Georgia, Athens, GA 30602-3013, USA.
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31
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Cao C, Markovitz M, Ferenczy S, Shields CL. Hand-held spectral-domain optical coherence tomography of small macular retinoblastoma in infants before and after chemotherapy. J Pediatr Ophthalmol Strabismus 2014; 51:230-4. [PMID: 25922867 DOI: 10.3928/01913913-20140603-01] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To demonstrate the utility of hand-held spectral-domain optical coherence tomography (SD-OCT) in assessing retinal structure in cases of macular retinoblastoma. METHODS In this retrospective, observational case series, three young children with macular retinoblastoma were treated at a tertiary care hospital. At examination under anesthesia, each patient was evaluated with SD-OCT for analysis of retinal tumor and macula. The main outcomes were retinal morphology before and after chemotherapy. RESULTS The mean patient age was 16 months (median: 9 months; range: 7 to 33 months). All patients had small exophytic macular retinoblastoma with subretinal fluid in the foveola. At presentation, the mean tumor thickness was 4.8 mm (range: 4.0 to 6.0 mm) and mean tumor base was 10.3 mm (range: 8.0 to 12.0 mm). SD-OCT documented tumor surface as smooth (n = 2) or irregular (n = 1), involvement of full-thickness retina (n = 3), and optical density as low (n = 3). The surrounding retina showed abrupt transition to tumor (n = 3), without intraretinal edema (n = 3), and with underlying subretinal fluid (n = 3). Following chemotherapy, all tumors showed regression with mean thickness of 2.6 mm (range: 2.2 to 3.0 mm). SD-OCT documented tumor surface as smooth (n = 1) or irregular (n = 2), and optical density as medium (n = 1) or high (n = 2). At the tumor site, the retina showed full-thickness disorganization but with abrupt transition to normal retina (n = 3). The foveola was anatomically intact (n = 1) or with outer retinal thinning (n = 2). Subretinal fluid was resolved in each case (n = 3). CONCLUSIONS SD-OCT can provide precise anatomic monitoring of the macular region in infants and young children with small macular retinoblastoma. This may serve as a guide for visual potential in the preverbal child.
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Frennesson CI, Nilsson SEG. A three-year follow-up of ranibizumab treatment of exudative AMD: impact on the outcome of carrying forward the last acuity observation in drop-outs. Acta Ophthalmol 2014; 92:216-20. [PMID: 23452436 DOI: 10.1111/aos.12091] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [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: 11/27/2022]
Abstract
PURPOSE To analyse a 3-year clinical patient cohort of ranibizumab treatment of exudative age-related macular degeneration (AMD), to investigate the impact on visual outcome of carrying forward the last acuity observation in drop-outs and to explore possible differences between the early and the late phase of the study. METHODS A retrospective study of 312 eyes with neovascular AMD. The patients were followed up monthly, received three initial monthly injections of 0.5 mg ranibizumab and were re-treated pro re nata (PRN). Time-domain optical coherence tomography (TD-OCT) was used until spectral-domain (SD)-OCT was introduced during the last year of enrolment. Sixty-five patients were discontinued from the study. PRIMARY OUTCOME change in best corrected visual acuity (BCVA). RESULTS Best corrected visual acuity was 58.4 (CI 56.9-59.9) ETDRS (Early Treatment Diabetic Retinopathy Study) letters. At three months, it had increased by 4.1 letters (p=0.0004), at 12 months by 1.8 letters, at 24 months by 1.0 letter and at 36 months by 0.1 letter. However, if the last available acuity of drop-outs was carried forward one step and included, acuity had increased by 3.9 letters at 3 months (p<0.0001) and by 1.0 letter at 12 months but had decreased by 3.8 letters at 24 months (p=0.019) and by 4.1 letters (p=0.003) at 36 months. At 24 months, the result was significantly (p=0.030) less favourable when drop-outs were included. In patients enrolled during the late phase, BCVA was 59.3 (CI 56.7-62.0). It had increased by 5.7 letters (p<0.0001) at three months and by 5.8 letters at 12 months (p=0.0016). In patients enrolled during the early phase, BCVA was 57.9 (CI 55.0-60.8). At three months, it had increased by 3.5 letters (p=0.0008), but at 12 months, it had decreased by 2.3 letters (ns). The result at 12 months was significantly (p=0.0033) better for the late than for the early phase. The number of injections was also significantly (p=0.011) higher in the late phase. Adverse events were similar to those in earlier clinical trials. CONCLUSIONS The results of this 3-year cohort showed that the initial average acuity could be maintained over 36 months, which was comparable to those of many other clinical cohorts. However, if the last available acuity of drop-outs was carried forward one step and included, the acuity figures would have fallen significantly. The results in patients enrolled during the late phase of the study were fairly similar to those in clinical trials.
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de Geus SJR, Jager MJ, Luyten GPM, Dijkman G. Shifting exudative age-related macular degeneration patients to ranibizumab after insufficient response to bevacizumab. Acta Ophthalmol 2013; 91:e411-3. [PMID: 23551594 DOI: 10.1111/aos.12090] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Morrow T. Injectable drug may help avoid eye surgery in patients with vitreomacular adhesion. Manag Care 2013; 22:49-50. [PMID: 23373143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Landrum J, Bone R, Mendez V, Valenciaga A, Babino D. Comparison of dietary supplementation with lutein diacetate and lutein: a pilot study of the effects on serum and macular pigment. Acta Biochim Pol 2012; 59:167-169. [PMID: 22428144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 03/01/2012] [Indexed: 05/31/2023]
Abstract
UNLABELLED The responses of subjects taking a 20 mg/day lutein diacetate supplement were compared with that for a 20 mg/day crystalline lutein or a placebo. Ten subjects, assigned to each of three groups, lutein diacetate (group 1), lutein (group 2), and a placebo (group 3), were supplemented for 24 weeks. Groups 1 and 2 consumed a dose equivalent to 20 mg per day of free lutein. Serum samples, collected at baseline, and at weeks 6, 12, 18, and 24 were analyzed by HPLC. Macular Pigment Optical Density (MPOD) was obtained by heterochromatic flicker photometry at baseline and weeks 6, 12, 18 and 24. RESULTS The average serum lutein concentrations for weeks 6 to 24 expressed as a ratio to the baseline value (±S.D.) were 5.52 ± 2.88 for group 1, 4.43 ± 1.61 for group 2, and 1.03 ± 0.25 for group 3. The median rate of macular pigment increase (milli-absorbance units/week) for groups 1, 2, and 3 were 2.35, 1.55, and 0.19 mAU/wk, respectively. P-values for these serum and MPOD increases are both highly significant when compared to placebo. The average serum response was about 25% higher for group 1 compared with group 2 and, the median MPOD response was 52% higher for group 1 than group 2. P-values calculated for the differences in these increases were, p = 0.066, marginally significant, for serum, and p = 0.09 approaching significance, for MPOD.
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Affiliation(s)
- John Landrum
- Department of Chemistry and Biochemistry, Florida International University, Miami, USA.
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Schoenberger SD, Miller DM, Petersen MR, Foster RE, Riemann CD, Sisk RA. Nepafenac for epiretinal membrane surgery. Ophthalmology 2011; 118:1482.e1-3. [PMID: 21724047 DOI: 10.1016/j.ophtha.2011.01.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Accepted: 01/11/2011] [Indexed: 11/19/2022] Open
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Udaondo P, Diaz-Llopis M, Garcia-Delpech S, Salom D, Arevalo JF. Microplasmin for vitreomacular traction. Ophthalmology 2010; 117:1859, 1859.e1; author reply 1859-60. [PMID: 20816250 DOI: 10.1016/j.ophtha.2010.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 06/01/2010] [Indexed: 11/29/2022] Open
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Rosen E. Endophthalmitis. J Cataract Refract Surg 2010; 36:191-2. [PMID: 20152594 DOI: 10.1016/j.jcrs.2009.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dimofte D, Danielescu C, Chiseliţă D. [Treatment with bevacizumab in exudative age-related macular degeneration]. Oftalmologia 2010; 54:116-122. [PMID: 20827921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES evaluation of the treatment with bevacizumab for advanced exudative AMD. MATERIAL AND METHOD prospective study on 163 patients (December 2006-February 2009). All patients received a series of 3 intravitreal injections with bevacizumab (1.25 mg/0.05 ml) at 6 weeks intervals followed by surveillance and continuation or restart of therapy based on clinical criteria and central macular thickness (CMT). The series was subdivided in three groups based on initial VA (VA < or = 0, 1; VA = 0, 1-0, 3; VA > or = 0,3). RESULTS Final VA increased or remained constant in 88% of patients. VA increased in all three groups: from 0.029 to 0.069 in the first group; from 0.152 to 0.245 in the second group; and from 0.409 to 0.612 in the third group. In all three groups the increase in VA achieved statistical significance (p < 0.001). The whole series manifested an anatomical improvement (final mean CMT of 243.3 microm, as compared to initial mean CMT of 345.3 microm). CONCLUSION intravitreal treatment with bevacizumab is efficient but should be followed by aggressive follow-up and rapid resume of the treatment if recurrence is diagnosed.
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Abstract
PURPOSE To report the functional and anatomical outcomes resulting from the use of intravitreal pegaptanib sodium (Macugen) in patients with diabetic macular oedema (DMO). METHODS We conducted a retrospective outcome analysis, by optical coherence tomography (OCT) and best-corrected visual acuity (BCVA), of eyes with DMO treated with intravitreal pegaptanib sodium. Moreover, we evaluated the foveal transverse photoreceptor (PR) band integrity in the OCT images at the time of the last follow-up visit. RESULTS Sixty-three eyes of 48 patients with a minimum of 6 months of follow-up were included for analysis. Intravitreal pegaptanib was found to produce significant improvements in mean BCVA (p = 0.019) and reductions in mean central macular thickness (CMT) (p < 0.001) as soon as the 6-week follow-up. Most eyes (60/63) required a mean of 3.03 +/- 0.9 repeated treatments, over a mean follow-up period of 6.7 +/- 1.2 months, to achieve significant improvements in mean BCVA (p < 0.001) and mean CMT (p < 0.001). In our series, the lower visual acuities tended to congregate in the group with the less-defined PR band (p < 0.001) and the lower CMT tended to congregate in the group with the best-defined PR band (p = 0.04), even though the higher CMT did not tend to congregate in the group with the less-defined PR band. CONCLUSION Our findings demonstrate that selective inhibition by intravitreal pegaptanib sodium of vascular endothelial growth factor (VEGF)-165 may produce a clinically meaningful and statistically significant benefit in the treatment of DMO.
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Affiliation(s)
- Giuseppe Querques
- Department of Ophthalmology, Riuniti Hospital, University of Foggia, Italy.
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Yeom HY, Hong S, Kim SS, Kim CY, Seong GJ. Influence of topical bimatoprost on macular thickness and volume in glaucoma patients with phakic eyes. Can J Ophthalmol 2008; 43:563-6. [PMID: 18982033 DOI: 10.3129/i08-092] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND In light of concern about the possible relation between the extensive clinical use of prostaglandin analogues and the development of retinal disorders such as cystoid macular edema, this study investigated the influence of topical application of bimatoprost 0.03% on macular thickness and volume in glaucoma patients with phakic eyes. METHODS A total of 40 eyes in 22 patients with primary open-angle glaucoma or normal-tension glaucoma were evaluated in this study. Optical coherence tomography images were taken before initiation of bimatoprost application and after 1, 2, and 3 months of treatment. In addition, best-corrected visual acuity (BCVA) and intraocular pressure (IOP) were measured, and contrast sensitivity tests and fundus examinations were performed. Changes in various parameters, including macular thickness and volume, were analyzed. RESULTS BCVA and contrast sensitivity did not change from baseline over the treatment period. IOP declined by 20% to 25% from baseline for 1 month before stabilizing. Macular thickness and volume did not increase significantly during the 3 months. INTERPRETATION Topical application of bimatoprost does not induce clinical or structural changes in the macula, at least in glaucoma patients with phakic eyes. Moreover, bimatoprost effectively lowered IOP without causing macular disorders such as cystoid macular edema.
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Abstract
OBJECTIVE The critical dose of chloroquine/hydroxychloroquine leading to a maculopathy or generalised retinopathy remains undetermined. In the literature, 100 g is considered the dose at which regular vision checks should be performed. Generally, chloroquine is said to be more toxic than hydroxychloroquine. A young patient presenting with toxic maculopathy after 57 g of hydroxychloroquine and a daily dosage of 2 mg/kg body weight prompted us to retrospectively look at our patients examined in this respect over about 1 year. METHODS The data of patients who were examined because of chloroquine/hydroxychloroquine intake or a respective maculopathy/retinopathy were retrospectively analysed. The time period was January 2005 until March 2006. Retinal damage was defined by fundus changes and alteration of the multifocal electroretinogram (ERG). RESULTS Twenty-one patients--18 women and three men--were examined. The mean age was 51 years (range 6-71). Five of the nine chloroquine-treated patients developed a maculopathy, and one of them developed an additional generalised retinopathy. Of the patients treated by hydroxychloroquine, three of 12 suffered from a maculopathy and one from an additional generalised retinopathy. The cumulative doses leading to retinal damage ranged from 170 g to 1650 g for chloroquine and from 57 g to 1190 g for hydroxychloroquine. The highest cumulative doses without leading to signs of retinopathy were 790 g for chloroquine and 1200 g for hydroxychloroquine. CONCLUSIONS There is a high variability of cumulative doses of chloroquine/hydroxychloroquine that lead to a toxic retinopathy. Therefore, early and regular ophthalmologic examinations are recommended. Electrophysiological testing should be performed once a year, corresponding to about 60 g of base with one tablet a day. For electrophysiology, the multifocal ERG has turned out to be the most important test in this regard. However, visual acuity and funduscopy should be performed more frequently.
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Affiliation(s)
- K Rüther
- Charitè-Augenklinik Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin.
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Ozkan B, Karabaş VL, Yüksel N, Cağlar Y. Serous retinal detachment in the macula related to latanoprost use. Int Ophthalmol 2007; 28:363-5. [PMID: 17805489 DOI: 10.1007/s10792-007-9137-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Accepted: 08/08/2007] [Indexed: 10/22/2022]
Abstract
A 67-year-old woman referred to our clinic complaining of decrease in vision and metamorphopsia for 1 month after initiating latanoprost therapy. Fundus examination and optical coherence tomography (OCT) revealed serous detachment in the macula. The macular thickness measured by OCT was 532 microm. Latanoprost was discontinued. At follow-up, a progressive decrease in macular thickness and increase in visual acuity was observed. Four months later, serous detachment was completely resolved, and macular thickness measured by OCT was 186 mum. Latanoprost may lead a serous retinal detachment in the posterior pole. Clinicians should keep in mind that decreased visual acuity in patients using latanoprost might be related with this complication.
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Affiliation(s)
- Berna Ozkan
- School of Medicine, Ophthalmology Department, Kocaeli University, Kocaeli, Turkey.
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Abstract
PURPOSE To compare intravitreal triamcinolone acetonide (IVT) versus natural course in refractory diabetic macular edema. METHODS In a prospective interventional case series, twenty five eyes with refractory DME which had been allocated to the sham group of a previous clinical trial underwent new examination and optical coherence tomography about 9 months after their first enrollment. Twenty eyes that met the inclusion criteria, visual acuity (VA) < 20/50 and central macular thickness (CMT) > 200 microm, were treated by 4 mg IVT. Evaluations were repeated at 2 and 4 months post-injection to imitate the similar examination intervals after sham injection. Corrected visual acuity and macular thickness changes following IVT were compared to the corresponding changes after sham injection (the natural course). RESULTS Visual acuity changes within and between each period were not statistically significant. Visual acuity decreased 0.08 & 0.09 logMAR by 2 months and 0.06 & 0.04 logMAR by 4 months after sham and IVT injections, respectively. The changes of macular thickness after IVT and sham intervention were not meaningful either. However, the difference between thickness changes by 4 months (52+/-50 microm increase after sham vs. 262+/-115 microm reduction after IVT) was significant (P=0.014). CONCLUSIONS Concerning macular thickness, IVT has beneficial effect on refractory diabetic macular edema as opposed to observation. However, considering visual acuity, it does not induce significant difference in comparison to the natural course of the disease.
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Affiliation(s)
- Alireza Ramezani
- Ophthalmic Research Center, Shaheed Beheshti Medical University, Tehran, Iran.
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Halfeld Furtado de Mendonça R, Maia OO, Yukihiko Takahashi W. Electrophysiologic findings in chloroquine maculopathy. Doc Ophthalmol 2007; 115:117-9. [PMID: 17562091 DOI: 10.1007/s10633-007-9060-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2007] [Revised: 04/25/2007] [Accepted: 04/28/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE To describe an interesting case with a typical chloroquine bull's eye maculopathy with important results of the electrophysiological tests and verify if any reduction of focal responses, detected in multifocal electroretinogram (mfERG), are congruent with any possible defects detected in the visual field. CASE REPORT A 59-year-old man took a daily dosage of 250 mg chloroquine for his rheumatoid arthritis (up to a total dose of 540 g). He had the typical chloroquine-induced bull's-eye maculopathy. The electro-oculogram was normal. The mfERG, demonstrated reduced focal responses in the areas corresponding to the scotoma detected in the visual field. CONCLUSIONS Considering the normality of the electro-oculogram, we can easily conclude that the electro-oculogram is not sensible to detect chloroquine maculopathy and that reported reductions may occur due to the course of the rheumatoid arthritis itself. The mfERG may be an important ophthalmological screening and follow-up management to investigate patients using chloroquine.
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Oztürk F, Yavas GF, Küsbeci T. The effect of ocular hypotensive agents on macula. Ann Ophthalmol (Skokie) 2007; 39:302-306. [PMID: 18025650 DOI: 10.1007/s12009-007-9006-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2007] [Revised: 11/30/1999] [Accepted: 06/29/2007] [Indexed: 05/25/2023]
Abstract
We evaluated the effect of long-term topical antiglaucoma drugs on the macula using the noninvasive macular visual field threshold test in 100 eyes of 75 patients with ocular hypertension or primary open-angle glaucoma. We found that topical antiglaucoma agents can alter macular sensitivity after long-term therapy and advise evaluation of the macula in glaucoma patients receiving antiglaucomatous agents.
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Affiliation(s)
- Faruk Oztürk
- Department of Ophthalmology, Faculty of Medicine, Afyon Kocatepe University, Afyonkarahisar, 03200, Turkey.
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Mozolewska-Piotrowska K, Lubiński W, Gosławski W, Karczewicz D, Szych Z. [Evaluation of retinal function after photodynamic therapy of subfoveal choroidal neovascularisation in patients with age-related macular degeneration]. Ann Acad Med Stetin 2007; 53 Suppl 1:16-21. [PMID: 19425475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION The aim of our study was to evaluate the visual acuity, visual field, retinal bioelectrical function and fluorescein angiography results in patients with subfoveal choroidal neovascularisation treated with photodynamic therapy (PDT). MATERIAL AND METHODS Visual acuity (Snellen chart), static perimetry (PS 30-2 W-W), mf-ERG (according to ISCEV standards) and fluorescein angiography were performed before, 3 and 6 months after initial photodynamic therapy in 20 eyes of 18 patients. RESULTS There was no significant change in the average visual acuity after 3 and 6 months after PDT comparing to the initial examination, although the visual acuity improved in individual cases from 1 to 5 lines. In the static perimetry a significant increase in PSD was observed after 3 and 6 months accompanied by a slight but non-significant improvement of foveal sensitivity at the same time. There was no significant changes in mfERG after 3 and 6 months except of decrease in P1 wave latency in ring 2 (p < 0.04 after 2 months and p < 0.02 after 6 months). Decrease in CNV activity area was detected in 45% of cases in FA examination. CONCLUSIONS There was no significant influence ofPDT on visual outcome and macular bioelectrical function in 3 and 6 months follow-up, despite stabilization or improvement in FA findings in majority of cases.
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