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Vatti T, Li H, Singh S, Seth K, Valentim C, Singh RP, Talcott KE. Association of macular hole intraretinal fluid and visual acuity. Can J Ophthalmol 2024; 59:e220-e226. [PMID: 37321556 DOI: 10.1016/j.jcjo.2023.05.006] [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: 01/06/2023] [Revised: 04/17/2023] [Accepted: 05/10/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE This study investigates the association between preoperative intraretinal fluid (IRF) area and preoperative and postoperative best-corrected visual acuity (BCVA) in surgically repaired idiopathic macular holes (MH). This study further evaluates other prognostic indices related to MH repair that may assist clinicians' understanding of MH operative management. DESIGN Retrospective cohort study conducted at a single institution. PARTICIPANTS A total of 251 patients who underwent surgery for idiopathic MH between January 2012 and January 2021. METHODS Segmentation was performed on ocular coherence tomography scans of 251 eyes with MH and IRF. Associations between IRF area and preoperative and postoperative BCVA at 1, 3, and 6 months, preoperative and postoperative central subfield thickness, MH diameter, staging, closure status, and type of closure were evaluated using Spearman's correlation analysis. RESULTS Preoperative IRF area was moderately correlated with preoperative BCVA (r = -0.32; p < 0.001) and negligibly correlated with postoperative BCVA at 1, 3, and 6 months (r = -0.14, p = 0.026; r = -0.21, p < 0.001; and r = -0.19, p < 0.001, respectively). Preoperative IRF area was strongly correlated with MH minimum linear diameter (r = 0.56; p < 0.001) and MH base diameter (r = 0.65; p < 0.001). Other associations were not statistically significant. CONCLUSION Preoperative IRF area in patients with idiopathic MH demonstrated a moderate correlation with preoperative BCVA and a negligible or weak correlation with postoperative BCVA at up to 6 months, suggesting that vision may not have a clinically significant relationship with IRF in the setting of MH.
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Affiliation(s)
- Thanvi Vatti
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Henry Li
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Sachin Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kanika Seth
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Carolina Valentim
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rishi P Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Katherine E Talcott
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
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Abraham JR, Singh RP, Srivastava SK, Mammo DA. HAIR TRANSPLANTATION COMPLICATED BY METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS SEPSIS AND ENDOGENOUS ENDOPHTHALMITIS. Retin Cases Brief Rep 2024; 18:301-304. [PMID: 36730419 DOI: 10.1097/icb.0000000000001384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 11/01/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To describe a case of endogenous endophthalmitis as a complication from hair transplantation. METHODS Case report of a 53-year-old man with a history of recent hair transplantation. RESULTS The patient presented with a febrile illness and blurry vision 1 week after hair transplantation. Infectious workup included blood cultures positive for methicillin-resistant Staphylococcus aureus, and he was treated with IV antibiotics. Initial ocular examination demonstrated 20/30 and hand motions in the right and left eyes, respectively, with significant vitritis. He underwent vitreous tap and injections of vancomycin and dexamethasone in both eyes and removal of purulent staple from the site of recently transplanted hair. His ocular and systemic symptoms improved. Approximately 3 months after initial clearing of the initial infection he had recurrence of bacteremia that prompted repeat intravitreal and systemic antibiotics. His vision returned to baseline with mild residual optic nerve pallor and atrophic retinal changes in the left eye. CONCLUSION Hair transplantation is associated with minimal systemic complications, but in rare cases, sepsis is possible and can result in intraocular seeding causing endophthalmitis. MRSA endogenous endophthalmitis frequently results in negative vitreous taps and treatment outcomes in the literature have been shown to vary widely including a return to baseline vision as in the described case.
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Affiliation(s)
- Joseph R Abraham
- Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio
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3
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von Schulthess EL, Maunz A, Chakravarthy U, Holekamp N, Pauleikhoff D, Patel K, Bachmeier I, Yu S, Cohen Y, Scherb MP, Jones IL, Gibson K, Willis JR, Glittenberg C, Singh RP, Fauser S. Intraretinal Hyper-Reflective Foci Are Almost Universally Present and Co-Localize With Intraretinal Fluid in Diabetic Macular Edema. Invest Ophthalmol Vis Sci 2024; 65:26. [PMID: 38758639 DOI: 10.1167/iovs.65.5.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024] Open
Abstract
Purpose In diabetic macular edema (DME), hyper-reflective foci (HRF) has been linked to disease severity and progression. Using an automated approach, we aimed to investigate the baseline distribution of HRF in DME and their co-localization with cystoid intraretinal fluid (IRF). Methods Baseline spectral-domain optical coherence tomography (SD-OCT) volume scans (N = 1527) from phase III clinical trials YOSEMITE (NCT03622580) and RHINE (NCT03622593) were segmented using a deep-learning-based algorithm (developed using B-scans from BOULEVARD NCT02699450) to detect HRF. The HRF count and volume were assessed. HRF distributions were analyzed in relation to best-corrected visual acuity (BCVA), central subfield thickness (CST), and IRF volume in quartiles, and Diabetic Retinopathy Severity Scores (DRSS) in groups. Co-localization of HRF with IRF was calculated in the central 3-mm diameter using the en face projection. Results HRF were present in most patients (up to 99.7%). Median (interquartile range [IQR]) HRF volume within the 3-mm diameter Early Treatment Diabetic Retinopathy Study ring was 1964.3 (3325.2) pL, and median count was 64.0 (IQR = 96.0). Median HRF volumes were greater with decreasing BCVA (nominal P = 0.0109), and increasing CST (nominal P < 0.0001), IRF (nominal P < 0.0001), and DRSS up to very severe nonproliferative diabetic retinopathy (nominal P < 0.0001). HRF co-localized with IRF in the en face projection. Conclusions Using automated HRF segmentation of full SD-OCT volumes, we observed that HRF are a ubiquitous feature in DME and exhibit relationships with BCVA, CST, IRF, and DRSS, supporting a potential link to disease severity. The spatial distribution of HRF closely followed that of IRF.
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Affiliation(s)
- Esther L von Schulthess
- Roche Pharma Research and Early Development, Therapeutic Modalities, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
- https://orcid.org/0000-0003-4497-8185
| | - Andreas Maunz
- Roche Pharma Research and Early Development, Therapeutic Modalities, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Usha Chakravarthy
- Queen's University of Belfast, Royal Victoria Hospital, Belfast, United Kingdom
| | - Nancy Holekamp
- Roche Pharma Research and Early Development, Therapeutic Modalities, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
- Pepose Vision Institute, Chesterfield, Missouri, United States
| | | | - Katie Patel
- Roche Products Ltd., Welwyn Garden City, United Kingdom
| | - Isabel Bachmeier
- Roche Pharma Research and Early Development, Therapeutic Modalities, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Siqing Yu
- Roche Pharma Research and Early Development, Therapeutic Modalities, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Yaniv Cohen
- Roche Pharma Research and Early Development, Therapeutic Modalities, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Mahnaz Parian Scherb
- Roche Pharma Research and Early Development, Therapeutic Modalities, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Ian L Jones
- Roche Pharma Research and Early Development, Therapeutic Modalities, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Kara Gibson
- Roche Products Ltd., Welwyn Garden City, United Kingdom
| | | | - Carl Glittenberg
- Roche Pharma Research and Early Development, Therapeutic Modalities, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Rishi P Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Sascha Fauser
- Roche Pharma Research and Early Development, Therapeutic Modalities, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
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Sharma N, Akotoye C, Perkins S, Sastry R, Wu AK, Singh RP, Franklin AJ, Rachitskaya A. Macular Holes in Tractional Retinal Detachments Secondary to Diabetic Retinopathy. J Vitreoretin Dis 2024; 8:317-324. [PMID: 38770075 PMCID: PMC11102715 DOI: 10.1177/24741264241239753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Purpose: To characterize the visual outcomes and rate of macular hole (MH) closure with tractional retinal detachment (TRD) and proliferative diabetic retinopathy (PDR). Methods: Visit data of patients who had pars plana vitrectomy were retrospectively reviewed; patient demographics, other procedure(s), the MH closure rate, and visual outcomes were also collected. Paired t, Fisher exact, and Mann-Whitney U tests were performed. Results: Ten patients (10 eyes) developed a TRD MH; 3 distinct MH presentations were identified. At the 3-month follow-up, 90% of MHs remained closed without the need for further reoperation (n = 6, type 1 closure; n = 3, type 2 closure). All MHs were closed 12 months after the initial surgery, with 1 eye requiring a single reoperation. The mean visual acuity (VA) at baseline and at 12 months was 20/235 and 20/138, respectively. Conclusions: MHs in the setting of fibrovascular proliferation resulting from PDR present with varied morphology. There is a high rate of MH closure and a trend toward improved VA.
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Affiliation(s)
- Neha Sharma
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Christian Akotoye
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Scott Perkins
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Resya Sastry
- Creighton University School of Medicine, Omaha, NE, USA
| | - Anna K. Wu
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Rishi P. Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
- Cleveland Clinic Martin Hospitals, Cleveland Clinic Florida, Stuart, FL, USA
| | | | - Aleksandra Rachitskaya
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Russell MW, Kumar M, Li A, Singh RP, Talcott KE. Incidence of ocular pathology following bariatric surgery for with morbid obesity across a large United States National Database. Eye (Lond) 2024:10.1038/s41433-024-03088-z. [PMID: 38678114 DOI: 10.1038/s41433-024-03088-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 03/07/2024] [Accepted: 04/11/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND/OBJECTIVES Bariatric surgery, as indicated for treatment of morbid obesity, has been studied in association with short term effects on ocular pathology. However, effects of surgery on postoperative disease incidence is largely unknown. SUBJECTS/METHODS In this retrospective cohort study, the TriNetX United States Collaborative Network national database, was queried for patients with an ICD-10 code for morbid obesity and a procedural code for bariatric surgery. Patients were propensity score matched across baseline demographics at the time of surgery and compared to those presenting with an ICD10 code for morbid obesity with no records of a procedural code for bariatric surgery, identifying 42,408 patients per cohort. New diagnoses or procedural codes found after the surgical index date for diabetic retinopathy, age-related macular degeneration, glaucoma, low vision, and blindness along with pertinent treatment metrics were monitored. RESULTS Bariatric surgery was found to be associated with reduced future risk of diabetic retinopathy (RR: 0.283; 95% CI: 0.252-0.319), macular edema (RR: 0.224; 95% CI: 0.170-0.297), vitreous hemorrhage (RR: 0.459; 95% CI: 0.323-0.653), ocular hypertension (RR: 0.387; 95% CI: 0.387-0.487), glaucoma (RR: 0.360; 95% CI: 0.326-0.399), use of ocular pressure lowering medications (RR: 0.565; 95% CI: 0.496-0.644), age-related macular degeneration (RR: 0.628; 95% CI: 0.447-0.882), cataract surgery (RR: 0.524; 95% CI: 0.448-0.612), and low vision and blindness (RR: 0.328; 95% CI: 0.294-0.365) compared to patients not surgically managed. CONCLUSIONS The present analysis comprising a large US cohort of patients suggests that bariatric surgery is associated with a decreased risk of future ocular morbidity and mortality.
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Affiliation(s)
- Matthew W Russell
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Madhukar Kumar
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ang Li
- Cleveland Clinic Cole Eye Institute, Cleveland, OH, USA
| | - Rishi P Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Cole Eye Institute, Cleveland, OH, USA
- Martin North Hospital, Cleveland Clinic, FL, USA
| | - Katherine E Talcott
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA.
- Cleveland Clinic Cole Eye Institute, Cleveland, OH, USA.
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Hom GL, Kuo BL, Ross JH, Chapman GC, Sharma N, Sastry R, Muste JC, Greenlee TE, Conti TF, Singh RP, Sharma S. Characterization of pentosan polysulfate patients for development of an alert and screening system for ophthalmic monitoring. Can J Ophthalmol 2024; 59:128-136. [PMID: 36878265 DOI: 10.1016/j.jcjo.2023.01.019] [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: 08/16/2022] [Revised: 12/27/2022] [Accepted: 01/30/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVE Pentosan polysulfate (PPS; ELMIRON, Janssen Pharmaceuticals, Titusville, NJ) is a U.S. Food and Drug Administration-approved oral medication for interstitial cystitis. Numerous reports have been published detailing retinal toxicity with the use of PPS. Studies characterizing this condition are primarily retrospective, and consequently, alert and screening systems need to be developed to actively screen for this disease. The goal of this study was to characterize ophthalmic monitoring trends of a PPS-using patient sample to construct an alert and screening system for monitoring this condition. METHODS A single-institution retrospective chart review was conducted between January 2005 and November 2020 to characterize PPS use. An electronic medical record (EMR) alert was constructed to trigger based on new PPS prescriptions and renewals offering ophthalmology referral. RESULTS A total of 1407 PPS users over 15 years was available for characterization, with 1220 (86.7%) being female, the average duration of exposure being 71.2 ± 62.6 months, and the average medication cumulative exposure being 669.7 ± 569.2 g. A total of 151 patients (10.7%) had a recorded visit with an ophthalmologist, with 71 patients (5.0%) having optical coherence tomography imaging. The EMR alert fired for 88 patients over 1 year, with 34 patients (38.6%) either already being screened by an ophthalmologist or having been referred for screening. CONCLUSIONS An EMR support tool can improve referral rates of PPS maculopathy screening with an ophthalmologist and may serve as an efficient method for longitudinal screening of this condition with the added benefit of informing pentosan polysulfate prescribers about this condition. Effective screening and detection may help determine which patients are at high risk for this condition.
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Affiliation(s)
- Grant L Hom
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Blanche L Kuo
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - James H Ross
- Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, Ohio
| | - Graham C Chapman
- Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, Ohio
| | - Neha Sharma
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Resya Sastry
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH
| | - Justin C Muste
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH
| | - Tyler E Greenlee
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH
| | - Thais F Conti
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH
| | - Rishi P Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH
| | - Sumit Sharma
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH.
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Gupta U, Maatouk CM, Markle JC, Talcott KE, Singh RP, Rachitskaya AV. Characterizing the Journey of Geographic Atrophy Patients in Routine Ophthalmic Practice. Ophthalmic Surg Lasers Imaging Retina 2024; 55:204-210. [PMID: 38319056 DOI: 10.3928/23258160-20240123-02] [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: 02/07/2024]
Abstract
BACKGROUND AND OBJECTIVE Geographic atrophy (GA) is a form of late-stage age-related macular degeneration (AMD). This study aims to characterize the journey of patients with GA in real-world ophthalmology practice. PATIENTS AND METHODS This is a retrospective cohort study of 100 patients with GA and 100 with intermediate AMD (iAMD). RESULTS Approximately one-third of GA patients' eyes had GA at the time of their initial AMD diagnosis, and nearly half of the iAMD patients' eyes had iAMD at that time. When holding confounders constant, GA patients experienced significantly worse visual acuity outcomes, and a significantly higher proportion required referrals for low vision evaluation, needed assistance for activities of daily living, failed to meet driving standards, and met criteria for legal blindness when compared to iAMD controls. CONCLUSIONS Many patients have already progressed to GA by the time they receive an AMD diagnosis, emphasizing the importance of providing early detection and intervention, especially considering novel treatment options. [Ophthalmic Surg Lasers Imaging Retina 2024;55:204-210.].
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8
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Talcott KE, Knapp AN, Amine R, Matar K, Srivastava SK, Rachitskaya A, Sharma S, Singh RP, Yuan A, Reese JL, Ehlers JP. Comparing Three-Dimensional Digitally Enabled Intraoperative OCT With Conventional Microscope-Integrated OCT in Vitreoretinal Surgery: A Post Hoc Analysis of the Discover Study. Ophthalmic Surg Lasers Imaging Retina 2024:1-8. [PMID: 38648428 DOI: 10.3928/23258160-20240206-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND AND OBJECTIVE This study compared the surgeon experience between conventional microscope-integrated intraoperative optical coherence tomography (iOCT) and digitally enabled microscope-integrated iOCT in vitreoretinal surgery. PATIENTS AND METHODS This is a post hoc case-control analysis of the DISCOVER study. Conventional microscope-integrated iOCT (Rescan 700, Zeiss) was compared with digitally enabled iOCT (Artevo 800, Zeiss). Compared variables included surgical field-based visualization (ie, ocular heads-up display in the conventional group; three-dimensional screen-based visualization in the digital iOCT group) and non-surgical field-based visualization (ie, review on the external two-dimensional monitor). RESULTS A total of 200 patients were included. Surgical field-based visualization of iOCT was significantly higher in the digitally enabled group (P < 0.0001). Required endoillumination level was significantly lower in the digital iOCT group (P < 0.0001). Surgeons reported "significant" back discomfort and headache more frequently when using conventional iOCT (P = 0.003 and P = 0.001, respectively). CONCLUSIONS Digitally enabled iOCT resulted in greater surgical visualization efficiency, appeared to require a lower illumination level, and may provide advantages for ergonomic-related discomfort. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].
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Jeong H, Maatouk CM, Russell MW, Singh RP. Associations between lipid abnormalities and diabetic retinopathy across a large United States national database. Eye (Lond) 2024:10.1038/s41433-024-03022-3. [PMID: 38521836 DOI: 10.1038/s41433-024-03022-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 02/21/2024] [Accepted: 03/07/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND/OBJECTIVES While dyslipidaemia has been suggested as a potential risk factor for diabetic retinopathy (DR), previous studies have reported conflicting findings. This study aimed to better characterize the relationship between abnormal serum levels of various lipid markers and the risk of the development and progression of DR. SUBJECTS/METHODS This retrospective cohort study utilized a United States national database of electronic medical records. Adults with a history of type 2 diabetes mellitus without type 1 diabetes mellitus were divided into cohorts based on the presence of abnormal serum levels of various lipid markers. Propensity score matching was performed to match cohorts with abnormal lipid levels to those with normal lipid levels on covariates. The cohorts were then compared to evaluate the hazard ratios (HR) of receiving a new DR diagnosis, pars plana vitrectomy, panretinal photocoagulation, vitreous haemorrhage, proliferative diabetic retinopathy, diabetic macular oedema (DMO), and traction retinal detachment. RESULTS The database contained 1,126,231 eligible patients (mean age: 60.8 [14.2] years; 46.0% female). Among patients without prior DR, low HDL (HR = 0.94, CI = 0.90-0.98), total cholesterol (HR = 0.88, CI = 0.85-0.91), and high triglyceride (HR = 0.91, CI = 0.86-0.97) levels were associated with a decreased risk of receiving a DR diagnosis. Among patients with preexisting DR, high LDL levels was associated with an increased risk of DMO (HR = 1.42, CI = 1.15-1.75), whereas low HDL levels was associated with a marginally decreased risk (HR = 0.92, CI = 0.85-0.99). CONCLUSIONS Elevated levels of markers of dyslipidaemia are inversely associated with the risk of receiving a DR diagnosis, but this relationship is blunted after the onset of DR.
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Affiliation(s)
- Hejin Jeong
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Christopher M Maatouk
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Matthew W Russell
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Rishi P Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA.
- Cleveland Clinic Martin Health, Cleveland Clinic Florida, Stuart, FL, USA.
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10
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Payne CJ, Gupta U, Maatouk CM, Kuo BL, Perkins SW, Singh RP, Talcott KE. Real-world effects of anti-vascular endothelial growth factor injection frequency on visual outcomes in patients with diabetic macular oedema. Eye (Lond) 2024:10.1038/s41433-024-02998-2. [PMID: 38448732 DOI: 10.1038/s41433-024-02998-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/16/2024] [Accepted: 02/15/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Anti-vascular endothelial growth factor (VEGF) injections are often administered less frequently in real-world treatment of diabetic macular oedema (DMO) than what was studied in clinical trials. This study aims to characterise real-world DMO treatment patterns and the effect of treatment intervals on patient outcomes. STUDY DESIGN/PATIENTS AND METHODS This was a retrospective study of 291 patients with DMO treated with anti-VEGF therapy. 12- and 24-month best visual acuity (BVA) and central subfield thickness (CST) were compared between injection interval groups, which were determined by averaging the two most recent injection intervals. Multiple linear regressions were performed to identify factors associated with injection interval, BVA, and CST. RESULTS 48.8% of patients received injections less than or equal to every 8 weeks (≤ q8w), 27.5% between every 8 to 12 weeks (q8-12w), and 23.7% greater than every 12 weeks (> q12w). Baseline CST was similar (p = 0.32), but BVA differed significantly in q8-12w patients (p = 0.0095). BVA and CST at 12 months were similar, but q8-12w patients experienced greater 12-month BVA improvement (7.36 ± 12.4 letters) than > q12w patients (1.26 ± 12.3 letters; p = 0.0056). 24-month BVA and CST changes were similar between groups (p = 0.30 and 0.87). Baseline BVA, HbA1c, and sex were associated with 12-month BVA, and baseline BVA and CST were associated with 12-month CST. CONCLUSION Many patients experienced improvements in BVA and CST over 12 months of treatment despite receiving less frequent anti-VEGF therapy than recommended in the pivotal trials. The present study showed that extended treatment intervals with bevacizumab were effective in preserving vision of many individuals with high baseline BVA.
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Affiliation(s)
- Carter J Payne
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Urvi Gupta
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Christopher M Maatouk
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Cleveland Clinic Cole Eye Institute Center for Ophthalmic Bioinformatics, Cleveland, OH, USA
| | - Blanche L Kuo
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Cleveland Clinic Cole Eye Institute Center for Ophthalmic Bioinformatics, Cleveland, OH, USA
| | - Scott W Perkins
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Rishi P Singh
- Cleveland Clinic Cole Eye Institute Center for Ophthalmic Bioinformatics, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Katherine E Talcott
- Cleveland Clinic Cole Eye Institute Center for Ophthalmic Bioinformatics, Cleveland, OH, USA.
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Singh RP, Avery RL, Barakat MR, Kim JE, Kiss S. Evidence-Based Use of Bevacizumab in the Management of Neovascular Age-Related Macular Degeneration. Ophthalmic Surg Lasers Imaging Retina 2024; 55:156-162. [PMID: 38466965 DOI: 10.3928/23258160-20240108-01] [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: 03/13/2024]
Abstract
Indicated for colorectal cancer for decades, bevacizumab has been widely used off label to treat retinal diseases, and the benefits of its use, specifically in neovascular age-related macular degeneration, have been demonstrated in multiple clinical trials. The intravitreal delivery of bevacizumab requires it to be aseptically repackaged into individual syringes by compounding pharmacies for use in the eye. Although the repackaging process is permitted by the US Food and Drug Administration, the resultant product does not meet the specific standards of products approved for use as ophthalmic injectables nor is the parenteral innovator solution compliant with ophthalmic standards. Studies have also demonstrated variability in the quality and quantity of repackaged bevacizumab. This narrative review summarizes the evidence and discusses the role of off-label bevacizumab in the treatment and management of retinal diseases, its mechanism of action, current challenges and provides a critical appraisal of current evidence, clinical implications, and future directions. [Ophthalmic Surg Lasers Imaging Retina 2024;55:155-162.].
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Shukla P, Sharma N, Shaia JK, Cohen DA, Singh RP, Talcott KE. The Risk of Optic Neuritis following mRNA Coronavirus Disease 2019 Vaccination Compared to Coronavirus Disease 2019 Infection and Other Vaccinations. Ophthalmology 2024:S0161-6420(24)00163-5. [PMID: 38408705 DOI: 10.1016/j.ophtha.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/07/2024] [Accepted: 02/20/2024] [Indexed: 02/28/2024] Open
Abstract
PURPOSE To determine the risk of optic neuritis (ON) after mRNA Coronavirus Disease 2019 (COVID-19) vaccine administration. DESIGN U.S. National aggregate database retrospective cohort study. PARTICIPANTS Patients were placed into cohorts based on mRNA COVID-19 vaccination status (no vaccine and positive history of COVID-19 infection, 1 vaccine, or 2 vaccines received) from December 2020 to June 2022. Two control cohorts were created with patients vaccinated against influenza or tetanus diphtheria and pertussis (Tdap) from June 2018 to December 2019. Patients with any history of ON or significant risk factors for ON development including infectious, inflammatory, and neoplastic diseases were excluded. METHODS A large deidentified database was queried for the Common Procedural Technology codes for immunization encounters specific to first dose and second dose of mRNA COVID-19 vaccine, influenza, or Tdap. Cohorts were 1:1 propensity score matched on age, sex, race, and ethnicity. The risk of ON development after vaccination was calculated and compared for all 5 cohorts with 95% confidence intervals (CIs) reported. MAIN OUTCOME MEASURES Risk ratio (RR) of ON 21 days after vaccination (or COVID-19 infection) and incidence of ON per 100 000 individuals. RESULTS After matching, the first dose COVID-19 and influenza vaccine cohorts (n = 1 678 598, mean age [standard deviation] at vaccination of 45.5 [23.3] years and 43.2 [25.5] years, 55% female) the RR of developing ON was 0.44 (95% CI, 0.28-0.80). The first dose of COVID-19 and Tdap vaccinations (n = 797 538, mean age 38.9 [20.0] years, 54.2% female) cohort had 10 and 16 patients develop ON (RR, 0.63; 95% CI, 0.28-1.38). Comparison of COVID-19-vaccinated patients (n = 3 698 848, 48.2 [21.5] years, 54.7% female) to unvaccinated and COVID-19-infected patients (n = 3 698 848, 49.6 [22.0] years, 55.2% female) showed 49 and 506 patients developing ON, respectively (RR, 0.09; 95% CI, 0.07-0.12). The incidence per 100 000 for ON was 1 in the first dose COVID-19 vaccine cohort, 2 in the influenza cohort, and 2 in the Tdap cohort, and 14 in the COVID-19-infected and unvaccinated cohorts. CONCLUSIONS Risk of ON after mRNA COVID-19 vaccination is rare and comparable to Tdap vaccination, decreased compared with influenza vaccination, and decreased compared with COVID-19 infection in the absence of vaccination. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Priya Shukla
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio; Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Neha Sharma
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jacqueline K Shaia
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Devon A Cohen
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Rishi P Singh
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio; Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio; Cleveland Clinic Martin Hospitals, Cleveland Clinic Florida, Stuart, Florida
| | - Katherine E Talcott
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio; Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
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Shukla P, Russell MW, Muste JC, Shaia JK, Kumar M, Nowacki AS, Hajj-Ali RA, Singh RP, Talcott KE. Propensity-Matched Analysis of the Risk of Age-Related Macular Degeneration with Systemic Immune-Mediated Inflammatory Disease. Ophthalmol Retina 2024:S2468-6530(24)00058-7. [PMID: 38320691 DOI: 10.1016/j.oret.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/23/2024] [Accepted: 01/30/2024] [Indexed: 05/23/2024]
Abstract
PURPOSE The pathogenesis of age-related macular degeneration (AMD) involves aberrant complement activation and is a leading cause of vision loss worldwide. Complement aberrations are also implicated in many systemic immune-mediated inflammatory diseases (IMIDs), but the relationship between AMD and these conditions remains undescribed. The aim of this study is to first assess the association between AMD and IMIDs, and then assess the risk of AMD in patients with specific IMIDs associated with AMD. DESIGN Cross-sectional study and cohort study. SUBJECTS AND CONTROLS Patients with AMD were compared with control patients with cataracts and no AMD to ensure evaluation by an ophthalmologist. Patients with IMIDs were compared with patients without IMIDs but with cataracts. METHODS This study used deidentified data from a national database (2006-2023), using International Classification of Diseases 10 codes to select for IMIDs. Propensity score matching was based on patients on age, sex, race, ethnicity, and smoking. Odds ratios were generated for IMIDs and compared between AMD and control patients. For IMIDs associated with AMD, the risk of AMD in patients with the IMID versus patients without IMIDs was determined utilizing a cohort study design. MAIN OUTCOME MEASURES Odds ratio of IMID, risk ratios (RRs), and 95% confidence intervals (CIs) of AMD diagnosis, given an IMID. RESULTS After propensity score matching, AMD and control cohorts (n = 217 197 each) had a mean ± standard deviation age of 74.7 ± 10.4 years, were 56% female, and 9% of patients smoked. Age-related macular degeneration showed associations with systemic lupus erythematosus (SLE), Crohn's disease, ulcerative colitis, rheumatoid arthritis (RA), psoriasis, sarcoidosis, scleroderma, giant cell arteritis, and vasculitis. Cohorts for each positively associated IMID were created and matched to control cohorts with no IMID history. Patients with RA (RR, 1.40; 95% CI, 1.30-1.49), SLE (RR, 1.73; 95% CI, 1.37-2.18), Crohn's disease (RR, 1.42; 95% CI, 1.20-1.71), ulcerative colitis (RR, 1.45; 95% CI, 1.29-1.63), psoriasis (RR, 1.48; 95% CI, 1.37-1.60), vasculitis (RR, 1.48; 95% CI, 1.33-1.64), scleroderma (RR, 1.65; 95% CI, 1.35-2.02), and sarcoidosis (RR, 1.42; 95% CI, 1.24-1.62) showed a higher risk of developing AMD compared with controls. CONCLUSIONS The results suggest that there is an increased risk of developing AMD in patients with RA, SLE, Crohn's disease, ulcerative colitis, psoriasis, vasculitis, scleroderma, and sarcoidosis compared with patients with no IMIDs. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Priya Shukla
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio; Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Matthew W Russell
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Justin C Muste
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Jacqueline K Shaia
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Madhukar Kumar
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Amy S Nowacki
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Rula A Hajj-Ali
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio; Department of Rheumatology and Immunologic Diseases, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Rishi P Singh
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio; Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio; Cleveland Clinic Martin Hospitals, Cleveland Clinic Florida, Stuart, Florida
| | - Katherine E Talcott
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio; Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
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Mohammadi S, Rezagholi F, Salehi MA, Zakavi SS, Jahanshahi A, Gouravani M, Yazdanpanah G, Jabbehdari S, Singh RP. Reply to "Methodologic lessons from published systematic reviews". Eye (Lond) 2024; 38:405. [PMID: 37587373 PMCID: PMC10811320 DOI: 10.1038/s41433-023-02692-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/21/2023] [Accepted: 08/02/2023] [Indexed: 08/18/2023] Open
Affiliation(s)
- Soheil Mohammadi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fateme Rezagholi
- School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran
| | | | - Seyed Sina Zakavi
- School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Jahanshahi
- School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mahdi Gouravani
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghasem Yazdanpanah
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
| | - Sayena Jabbehdari
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Rishi P Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA.
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Steinkerchner MS, Russell MW, Sharma N, Kumar M, Talcott KE, Singh RP. Long-Term Visual Outcomes in Patients With Idiopathic Epiretinal Membrane Surgery. Ophthalmic Surg Lasers Imaging Retina 2024; 55:71-77. [PMID: 38198614 DOI: 10.3928/23258160-20231207-02] [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: 01/12/2024]
Abstract
BACKGROUND AND OBJECTIVE Our aim was to assess long-term outcomes following surgical repair of idiopathic epiretinal membrane (ERM) with pars plana vitrectomy (PPV) and membrane peel (MP). PATIENTS AND METHODS A retrospective study evaluated patients with idiopathic ERM who underwent surgical repair at a single academic tertiary center with five to nine years of postoperative follow-up, assessing preoperative characteristics, surgical techniques, best visual acuity (BVA), and optical coherence tomography biomarkers at various time points. RESULTS The study involved 67 patients (72 eyes) with an average postoperative follow-up of 82.8 ± 18.8 months. Patients with cone outer segment tips integrity at initial presentation and 1-year follow-up and patients with external limiting membrane and ellipsoid zone integrity at 1-year follow-up were noted to have significantly better long-term visual acuity than those without. More than 85% of patients achieved a BVA > 70 seven years after surgical repair. CONCLUSIONS Vitreoretinal surgery for idiopathic ERM resulted in improved anatomical recovery and sustained visual acuity gain over long-term follow-up. [Ophthalmic Surg Lasers Imaging Retina 2024;55:70-77.].
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Valentim CCS, Wu AK, Yu S, Manivannan N, Zhang Q, Cao J, Song W, Wang V, Kang H, Kalur A, Iyer AI, Conti T, Singh RP, Talcott KE. Deep learning-based algorithm for the detection of idiopathic full thickness macular holes in spectral domain optical coherence tomography. Int J Retina Vitreous 2024; 10:9. [PMID: 38263402 PMCID: PMC10804727 DOI: 10.1186/s40942-024-00526-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/04/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Automated identification of spectral domain optical coherence tomography (SD-OCT) features can improve retina clinic workflow efficiency as they are able to detect pathologic findings. The purpose of this study was to test a deep learning (DL)-based algorithm for the identification of Idiopathic Full Thickness Macular Hole (IFTMH) features and stages of severity in SD-OCT B-scans. METHODS In this cross-sectional study, subjects solely diagnosed with either IFTMH or Posterior Vitreous Detachment (PVD) were identified excluding secondary causes of macular holes, any concurrent maculopathies, or incomplete records. SD-OCT scans (512 × 128) from all subjects were acquired with CIRRUS™ HD-OCT (ZEISS, Dublin, CA) and reviewed for quality. In order to establish a ground truth classification, each SD-OCT B-scan was labeled by two trained graders and adjudicated by a retina specialist when applicable. Two test sets were built based on different gold-standard classification methods. The sensitivity, specificity and accuracy of the algorithm to identify IFTMH features in SD-OCT B-scans were determined. Spearman's correlation was run to examine if the algorithm's probability score was associated with the severity stages of IFTMH. RESULTS Six hundred and one SD-OCT cube scans from 601 subjects (299 with IFTMH and 302 with PVD) were used. A total of 76,928 individual SD-OCT B-scans were labeled gradable by the algorithm and yielded an accuracy of 88.5% (test set 1, 33,024 B-scans) and 91.4% (test set 2, 43,904 B-scans) in identifying SD-OCT features of IFTMHs. A Spearman's correlation coefficient of 0.15 was achieved between the algorithm's probability score and the stages of the 299 (47 [15.7%] stage 2, 56 [18.7%] stage 3 and 196 [65.6%] stage 4) IFTMHs cubes studied. CONCLUSIONS The DL-based algorithm was able to accurately detect IFTMHs features on individual SD-OCT B-scans in both test sets. However, there was a low correlation between the algorithm's probability score and IFTMH severity stages. The algorithm may serve as a clinical decision support tool that assists with the identification of IFTMHs. Further training is necessary for the algorithm to identify stages of IFTMHs.
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Affiliation(s)
- Carolina C S Valentim
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, 9500 Euclid Ave. i32, Cleveland, OH, USA
| | - Anna K Wu
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, 9500 Euclid Ave. i32, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Sophia Yu
- Carl Zeiss Meditec, Inc, Dublin, CA, USA
| | | | | | - Jessica Cao
- Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Weilin Song
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Victoria Wang
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Hannah Kang
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Aneesha Kalur
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, 9500 Euclid Ave. i32, Cleveland, OH, USA
| | - Amogh I Iyer
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, 9500 Euclid Ave. i32, Cleveland, OH, USA
| | - Thais Conti
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, 9500 Euclid Ave. i32, Cleveland, OH, USA
| | - Rishi P Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, 9500 Euclid Ave. i32, Cleveland, OH, USA
| | - Katherine E Talcott
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, 9500 Euclid Ave. i32, Cleveland, OH, USA.
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Nirwan N, Siddiqui A, Kannemadugu HBS, Chauhan P, Singh RP. Determining hotspots of gaseous criteria air pollutants in Delhi airshed and its association with stubble burning. Sci Rep 2024; 14:986. [PMID: 38200112 PMCID: PMC10782015 DOI: 10.1038/s41598-023-51140-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/31/2023] [Indexed: 01/12/2024] Open
Abstract
Transboundary pollutant transport is considered as one of the primary factors causing the seasonal air quality deterioration in Delhi, India's capital. The highest standard deviations exceeding days in winter for NO2 (7.14-9.63%) and SO2 (4.04-7.42%) in 2019-2022 underscore the role of meteorological conditions in Delhi's pollution. In contrast, the post-monsoon season shows the highest pollutant exceedance days (4.52-8.00%) for CO due to stubble burning (SB) in Punjab (68,902 fires/year). Despite the government's assertions of decreasing SB events (14.68%), the city's CO exceedance days persistently rose by 6.36%. CAMS data is used for assessing contribution hotspots through back-trajectory analysis at multiple heights. An overlap hotspot of 111 sq. km area is identified in the Southeast parts of Punjab that have a higher contribution to the CO levels in Delhi during the post-monsoon season of 2019. Similarly, hotspots are also observed for SO2 over industrial areas of Punjab during the post-monsoon and pre-monsoon seasons. The same seasons show similar contributing patterns for NO2 highlighting the influence of consistent emission patterns and meteorological conditions. The clear delineation of hotspots using the receptor model at multiple heights coupled with source apportionment studies will assist decision-makers in addressing the pollution sources outside Delhi.
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Affiliation(s)
- Nirwan Nirwan
- Urban and Regional Studies Department, Indian Institute of Remote Sensing, Indian Space Research Organisation, 4-Kalidas Road, Dehradun, Uttarakhand, 248001, India.
| | - Asfa Siddiqui
- Urban and Regional Studies Department, Indian Institute of Remote Sensing, Indian Space Research Organisation, 4-Kalidas Road, Dehradun, Uttarakhand, 248001, India
| | | | - Prakash Chauhan
- National Remote Sensing Centre, Indian Space Research Organisation, Hyderabad, Telangana, 500037, India
| | - R P Singh
- Urban and Regional Studies Department, Indian Institute of Remote Sensing, Indian Space Research Organisation, 4-Kalidas Road, Dehradun, Uttarakhand, 248001, India
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Vatti T, Chong DD, Maatouk CM, Das N, Gendi S, Schachat AP, Singh RP, Talcott KE. Visual acuity changes in the preoperative period in patients undergoing cataract surgery. Can J Ophthalmol 2024:S0008-4182(23)00363-0. [PMID: 38182120 DOI: 10.1016/j.jcjo.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/04/2023] [Accepted: 11/20/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE This study quantifies change in best visual acuity (BVA) over the preoperative period and assesses factors associated with postoperative outcomes. DESIGN Retrospective chart review conducted at a single institution. PARTICIPANTS A total of 691 patients underwent cataract surgery and had a preoperative assessment 0-30 days prior to surgery following their surgical evaluation. METHODS Baseline demographics and past medical and clinical data were collected through electronic medical record query. BVA was noted at initial surgical evaluation, preoperative assessment, and nearest postoperative assessment. RESULTS A total of 691 patients (911 eyes) were included with mean BVAs at the initial evaluation, preoperative assessment, and postoperative assessment of 68.3 ± 16.8, 64.6 ± 18.5, and 81.1 ± 12.0 ETDRS letters, respectively. Mean BVA was significantly higher postoperatively compared with the preoperative assessment and initial evaluation (p < 0.0001). There was a mean of 53.8 days between initial surgical evaluation and surgery date and a mean of 49.9 days between the preoperative assessment and initial surgical evaluation. The mean interval between the preoperative assessment and surgery was 11.7 days. In the preoperative period, 9.1% of eyes experienced worsening of BVA by >3 eyes and 0.9% experienced improvement of BVA by >3 lines. Time to surgery was significantly associated with change in postoperative BVA (effect size, -0.03 ETDRS letters; p = 0.015) but was not significant on multiple linear regression. BVA at initial evaluation, glaucoma, and glaucoma surgery were all significantly associated with postoperative outcomes. CONCLUSION Most eyes experienced stable vision in the preoperative period for cataract surgery. On average, patients with high BVAs at the time of initial surgical evaluation may be able to defer surgery without the risk of poorer surgical outcomes.
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Affiliation(s)
- Thanvi Vatti
- Case Western Reserve University School of Medicine, Cleveland, Oh
| | - David D Chong
- Case Western Reserve University School of Medicine, Cleveland, Oh
| | - Christopher M Maatouk
- Case Western Reserve University School of Medicine, Cleveland, Oh; Center for Ophthalmic Bioinformatics, Cleveland Clinic Cole Eye Institute, Cleveland, OH
| | - Nikhil Das
- Center for Ophthalmic Bioinformatics, Cleveland Clinic Cole Eye Institute, Cleveland, OH
| | - Steve Gendi
- Case Western Reserve University School of Medicine, Cleveland, Oh
| | | | - Rishi P Singh
- Center for Ophthalmic Bioinformatics, Cleveland Clinic Cole Eye Institute, Cleveland, OH; Cleveland Clinic Martin Hospitals, Cleveland Clinic Florida, Stuart, FL
| | - Katherine E Talcott
- Center for Ophthalmic Bioinformatics, Cleveland Clinic Cole Eye Institute, Cleveland, OH; Cleveland Clinic Cole Eye Institute, Cleveland, OH.
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Kailar RS, Kuo BL, Perkins SW, Singh RP. Long-Term Outcomes in Early versus Limited Response to Anti-VEGF Treatment for Retinal Vein Occlusion. Ophthalmol Retina 2024; 8:55-61. [PMID: 37595685 DOI: 10.1016/j.oret.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/23/2023] [Accepted: 08/07/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVE Macular edema secondary to retinal vein occlusion (RVO) is a sight-threatening condition. Previous studies showed that early responders (ERs) who respond well to anti-VEGF injections within 3 months of treatment have better outcomes, as measured by best visual acuity (BVA) and central subfield thickness (CST) at 12 months postinjection initiation compared with limited early responders (LERs). This study analyzed whether ER eyes continue to respond better than LER eyes over longer periods. This study also aimed to identify baseline comorbidities associated with response status. DESIGN Retrospective cohort study. PARTICIPANTS Patients aged > 18 years with RVO-related macular edema treated with anti-VEGF injections. METHODS Patients were categorized as ERs or LERs. Limited early responder eyes were defined as having CST reduction < 10%, BVA gain < 5 ETDRS letters, or both at 3 months after anti-VEGF initiation. Best visual acuity and CST changes over the 24- and 36-month period after the first anti-VEGF treatment were compared between ERs and LERs. Patient characteristics and systemic comorbidities were identified by chart review. Statistical analysis involved the Levene test, Welch t test, and Welch analysis of variance. MAIN OUTCOME MEASURES Best visual acuity and CST changes over the initial 24-month and 36-month periods after treatment. RESULTS The 24-month cohort included 68 ERs and 39 LERs, and the 36-month cohort included 58 ERs and 33 LERs. At the 24-month time point, there were significant differences in BVA and CST gains between ERs (+19.8 letters, -221.2 um) and LERs (-2.4 letters, -90.1 um; P < 0.001, P < 0.01). Similarly, at 36 months, there were significant differences in BVA and CST gains between ERs (+17.7 letters, -229.3 um) and LERs (+1.3 letters, -128 um; P < 0.001, P < 0.05). After controlling for differences in baseline BVA and CST, only the 24-month change in BVA remained significant (P < 0.001). There were no significant associations between response status and cardiopulmonary, endocrine, and oncologic comorbidities. CONCLUSIONS Early responder eyes with branched retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO) have better functional responses to anti-VEGF injections at 24 months compared with LER eyes, even after controlling for baseline differences. Early identification of eyes as ERs or LERs in BRVO and CRVO may predict long-term functional prognoses. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Roshni S Kailar
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Blanche L Kuo
- Case Western Reserve University School of Medicine, Cleveland, Ohio; Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Scott W Perkins
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Rishi P Singh
- Case Western Reserve University School of Medicine, Cleveland, Ohio; Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Martin Hospitals, Cleveland Clinic Florida, Stuart, Florida.
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Talcott KE, Valentim CCS, Perkins SW, Ren H, Manivannan N, Zhang Q, Bagherinia H, Lee G, Yu S, D'Souza N, Jarugula H, Patel K, Singh RP. Automated Detection of Abnormal Optical Coherence Tomography B-scans Using a Deep Learning Artificial Intelligence Neural Network Platform. Int Ophthalmol Clin 2024; 64:115-127. [PMID: 38146885 DOI: 10.1097/iio.0000000000000519] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
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21
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Singuri S, Luo S, Hatipoglu D, Nowacki AS, Patel R, Schachat AP, Ehlers JP, Singh RP, Anand-Apte B, Yuan A. Clinical Utility of Spectral-Domain Optical Coherence Tomography Marker Disorganization of Retinal Inner Layers in Diabetic Retinopathy. Ophthalmic Surg Lasers Imaging Retina 2023; 54:692-700. [PMID: 38113360 DOI: 10.3928/23258160-20231031-02] [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: 12/21/2023]
Abstract
BACKGROUND AND OBJECTIVE Disorganization of retinal inner layers (DRIL) is a potential spectral-domain optical coherence tomography (SD-OCT) imaging biomarker with clinical utility in diabetic retinopathy (DR). PATIENTS AND METHODS A cross-sectional study was conducted at a large academic center. The cohort was composed of 1,175 patients with type 2 diabetes with and without retinopathy on initial examination between September 2009 and January 2019 (n = 2,083 eyes). DR risk and progression factors were obtained from the medical record. Trained graders masked to patients' clinical histories evaluated SD-OCT scans for DRIL. RESULTS Of 2,083 eyes, 28.1% (n = 585) demonstrated presence of DRIL with high interrater reliability (K = 0.88, 95% CI 0.86-0.90). DRIL was associated with worse visual acuity (VA) (P < 0.001) and DR severity (P < 0.0001). Insulin users had more severe DR (P < 0.0001). DR-related factors, race (Black, White) and sex (male) were significantly associated with DRIL (P < 0.05). CONCLUSIONS DRIL was strongly associated with DR severity and worse VA, supporting its utility as an unfavorable prognostic indicator. [Ophthalmic Surg Lasers Imaging Retina 2023;54:692-700.].
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22
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Singh RP, Barakat MR, Ip MS, Wykoff CC, Eichenbaum DA, Joshi S, Warrow D, Sheth VS, Stefanickova J, Kim YS, He F, Cho GE, Wang Y, Emanuelli A. Efficacy and Safety of Brolucizumab for Diabetic Macular Edema: The KINGFISHER Randomized Clinical Trial. JAMA Ophthalmol 2023; 141:1152-1160. [PMID: 37971723 DOI: 10.1001/jamaophthalmol.2023.5248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Importance Despite the effectiveness of existing anti-vascular endothelial growth factor (VEGF) therapies, a need remains for further treatment options to improve response rates and/or reduce injection or monitoring frequency in patients with diabetic macular edema (DME). Objective To evaluate the efficacy and safety of brolucizumab vs aflibercept dosed every 4 weeks in participants with DME. Design, Participants, and Setting This 52-week, double-masked, phase 3 randomized clinical trial included treatment-naive adults and adults who had previously received anti-VEGF therapy. Data were collected from September 2019 to March 2020, and data were analyzed from April 2020 to February 2021. Intervention Brolucizumab, 6 mg, intravitreal injection every 4 weeks or aflibercept, 2 mg, intravitreal injection every 4 weeks. Main Outcomes and Measures Participants were randomized 2:1 to brolucizumab, 6 mg, or aflibercept, 2 mg. The primary end point was change from baseline in best-corrected visual acuity at week 52. Secondary end points were the proportion of participants with a 2-step improvement or greater from baseline in Diabetic Retinopathy Severity Scale score, the proportion of eyes with absence of both subretinal fluid and intraretinal fluid, change from baseline in central subfield thickness, and safety at week 52. Results A total of 517 participants were randomized to brolucizumab (n = 346) or aflibercept (n = 171); 299 (57.8%) were male, and the mean (SD) age was 60.7 (10.2) years. Brolucizumab was noninferior to aflibercept in best-corrected visual acuity (Early Treatment Diabetic Retinopathy Study letter score) change from baseline at week 52 (brolucizumab, 12.2-letter improvement; aflibercept, 11.0-letter improvement; difference, 1.1; 95% CI, -0.6 to 2.9; noninferiority margin, 4; P < .001). Brolucizumab was superior to aflibercept for the proportion of eyes without subretinal and intraretinal fluid (brolucizumab, 144 of 346 [41.6%]; aflibercept, 38 of 171 [22.2%]; difference, 20.0%; 95% CI, 12.5to 28.6; P < .001) and mean central subfield thickness change from baseline at week 52 (brolucizumab, -237.8 μm; aflibercept, -196.5 μm; difference, -41.4; 95% CI, -58.9 to -23.8; P < .001). Incidence of intraocular inflammation was 4.0% (14 of 346) in the brolucizumab arm and 2.9% (5 of 171) in the aflibercept arm, incidence of retinal vasculitis was 0.9% (3 of 346) and 0.6% (1 of 171), respectively, and incidence of retinal vascular occlusion was 0.3% (1 of 346) and 0.6% (1 of 171). One participant in the brolucizumab arm had retinal artery occlusion. Conclusions and Relevance In these study participants with DME, no clinically meaningful differences in visual outcomes were noted between the brolucizumab and aflibercept arms; some superior anatomic improvements were noted in the brolucizumab arm. No new safety concerns were identified. Trial Registration ClinicalTrials.gov Identifier: NCT03917472.
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Affiliation(s)
- Rishi P Singh
- Cleveland Clinic Martin Hospitals, Cleveland Clinic Florida, Stuart
| | - Mark R Barakat
- Retinal Consultants of Arizona, Phoenix
- University of Arizona College of Medicine, Phoenix
| | - Michael S Ip
- Doheny Eye Institute, UCLA Department of Ophthalmology, University of California, Los Angeles
| | | | - David A Eichenbaum
- Retina Vitreous Associates of Florida, St Petersburg
- Morsani College of Medicine, University of South Florida, Tampa
| | | | - David Warrow
- Cumberland Valley Retina Consultants, Hagerstown, Pennsylvania
| | - Veeral S Sheth
- University Retina and Macula Associates, Chicago, Illinois
| | - Jana Stefanickova
- Department of Ophthalmology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | | | - Fanyin He
- Beijing Novartis Pharma, Beijing, China
| | - Ga Eun Cho
- Novartis Pharmaceuticals, East Hanover, New Jersey
| | | | - Andrés Emanuelli
- Department of Ophthalmology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
- Emanuelli Research and Development Center, Arecibo, Puerto Rico
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Das N, Chaurasia S, Singh RP. A review of emerging tyrosine kinase inhibitors as durable treatment of neovascular age-related macular degeneration. Expert Opin Emerg Drugs 2023; 28:203-211. [PMID: 37796039 DOI: 10.1080/14728214.2023.2259790] [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: 08/10/2023] [Accepted: 09/13/2023] [Indexed: 10/06/2023]
Abstract
INTRODUCTION Current treatment for age-related macular degeneration poses a large burden on patients and the inability of patients to adhere to this immense burden can lead to worse visual outcomes. Novel treatments have been proposed to extend treatment intervals and reduce visit burden. AREAS COVERED This review article summarizes phase I and phase II clinical trials of tyrosine kinase inhibitors as durable treatment options for patient with neovascular age-related macular degeneration. EXPERT OPINION Tyrosine kinase inhibitors have shown substantial promise in reducing treatment burden while maintaining visual acuity and anatomic outcomes with favorable safety profiles. Several platforms have shown positive outcomes in initial trials and are currently moving toward phase III clinical trials.
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Affiliation(s)
- Nikhil Das
- Center for Ophthalmic Bioinformatics, Cleveland Clinic Cole Eye Institute, Cleveland, OH, USA
| | - Sameer Chaurasia
- Department of Ophthalmology, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Rishi P Singh
- Center for Ophthalmic Bioinformatics, Cleveland Clinic Cole Eye Institute, Cleveland, OH, USA
- Cleveland Clinic Martin Hospitals, Cleveland Clinic Florida, Stuart, FL, USA
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24
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Shaia JK, Shukla P, Singh RP. Risk of New Retinal Vascular Occlusion After Messenger RNA COVID-19 Vaccination Within Aggregated Electronic Health Record Data-Reply. JAMA Ophthalmol 2023; 141:1177-1178. [PMID: 37943544 DOI: 10.1001/jamaophthalmol.2023.5085] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Affiliation(s)
- Jacqueline K Shaia
- Department of Population and Quantitative Health Sciences, Case Western School of Medicine, Cleveland, Ohio
- Center for Ophthalmic Bioinformatics, Cleveland Clinic, Cleveland, Ohio
| | - Priya Shukla
- Center for Ophthalmic Bioinformatics, Cleveland Clinic, Cleveland, Ohio
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Rishi P Singh
- Center for Ophthalmic Bioinformatics, Cleveland Clinic, Cleveland, Ohio
- Cleveland Clinic Martin Hospitals, Cleveland, Ohio
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25
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Agrawal A, Varshney R, Gattani A, Hira Khan M, Gupta R, Solanki KS, Patel SK, Singh RP, Singh P. Development of Hemagglutinin-Neuraminidase Homologous Peptides as Novel Promising Therapeutic Agents Against Peste des Petits Ruminants Virus. Protein J 2023; 42:685-697. [PMID: 37421558 DOI: 10.1007/s10930-023-10134-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/10/2023]
Abstract
The lack of specific antiviral therapy and complications associated with the existing peste des petits ruminants (PPR) vaccines accentuates the search of novel antiviral blocking agents in order to curtail the PPR infection at initial level. The synthetic hemagglutinin-neuraminidase (HN) homologous peptides may compete with the natural HN protein of PPR virus for binding to signaling lymphocytic activation molecule (SLAM) receptor, consequently, may disrupt peste des petits ruminants virus (PPRV) at entry level. Therefore, insilico analysis, synthesis, purification and subsequent characterization of HN homologous peptides were conducted in this study. The HN homologous peptides were synthesized by means of solid phase chemistry and were purified by reversed-phase-high performance liquid chromatography. The mass as well as sequence of HN homologous peptides were assessed by mass spectroscopy while its secondary structure was elucidated by circular dichroism spectroscopy. The binding (interaction) efficacy of HN homologous peptides with PPRV antibodies was assessed via indirect enzyme linked immunosorbent assay, visual detection test (red wine to purple), bathochromic shift under UV-Vis spectrophotometry and lateral flow immunochromatographic strip test. The antiviral properties and cytotoxicity of these peptides were also assessed in B95a cell line with changes in cytopathic effect and titer of PPRV (Sungri/96). The presence of green fluorescein isothiocyanate over the B95a cell surface pointed towards the binding of HN homologous peptides with surface SLAM receptor. Moreover, the intact beta sheet configuration in water and lower cytotoxicity [cytotoxic concentration 50 (CC50) > 1000 µg/ml] of these peptides signifies its in vivo use. Among HN homologous peptides, the binding efficacy and antiviral properties of pep A was relatively high in comparison to pep B and Pep ppr peptides. The prerequisite concentration of HN homologous peptides (pep A = 12.5 µg/ml; pep B = 25 µg/ml; pep ppr = 25 µg/ml) to exemplify its antiviral effect was much lower than its CC50 level. Hence, this study signifies the therapeutic potential of synthetic HN homologous peptides.
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Affiliation(s)
- Aditya Agrawal
- Division of Animal Biochemistry, IVRI, Izatnagar, Bareilly, U.P., 243122, India.
- Department of Veterinary Physiology and Biochemistry, College of Veterinary Science and Animal husbandry, NDVSU, Rewa, Jabalpur, 486001, India.
| | - Rajat Varshney
- Department of Veterinary Microbiology, BHU, Mirzapur, U.P., 231001, India
- Division of Bacteriology and Mycology, IVRI, Izatnagar, Bareilly, U.P., 243122, India
| | - Anil Gattani
- Division of Animal Biochemistry, IVRI, Izatnagar, Bareilly, U.P., 243122, India
- Department of Veterinary Physiology and Biochemistry, College of Veterinary Science and Animal husbandry, NDVSU, Jabalpur, 486001, India
| | - Mahvash Hira Khan
- Division of Animal Biochemistry, IVRI, Izatnagar, Bareilly, U.P., 243122, India
- Department of Veterinary Physiology and Biochemistry, College of Veterinary Science and Animal husbandry, NDVSU, Jabalpur, 486001, India
| | - Rohini Gupta
- Department of Veterinary Medicine, College of Veterinary Science and Animal husbandry, NDVSU, Jabalpur, 486001, India
| | - Khushal Singh Solanki
- Division of Veterinary Biotechnology, IVRI, Izatnagar, Bareilly, U.P., 243122, India
| | - Shailesh Kumar Patel
- Department of Veterinary Pathology, College of Veterinary Science and Animal husbandry, NDVSU, Rewa, Jabalpur, 486001, India
| | - R P Singh
- Division of Bacteriology and Mycology, IVRI, Izatnagar, Bareilly, U.P., 243122, India
| | - Praveen Singh
- Division of Animal Biochemistry, IVRI, Izatnagar, Bareilly, U.P., 243122, India
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26
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Robinson ML, Hahn PG, Inouye BD, Underwood N, Whitehead SR, Abbott KC, Bruna EM, Cacho NI, Dyer LA, Abdala-Roberts L, Allen WJ, Andrade JF, Angulo DF, Anjos D, Anstett DN, Bagchi R, Bagchi S, Barbosa M, Barrett S, Baskett CA, Ben-Simchon E, Bloodworth KJ, Bronstein JL, Buckley YM, Burghardt KT, Bustos-Segura C, Calixto ES, Carvalho RL, Castagneyrol B, Chiuffo MC, Cinoğlu D, Cinto Mejía E, Cock MC, Cogni R, Cope OL, Cornelissen T, Cortez DR, Crowder DW, Dallstream C, Dáttilo W, Davis JK, Dimarco RD, Dole HE, Egbon IN, Eisenring M, Ejomah A, Elderd BD, Endara MJ, Eubanks MD, Everingham SE, Farah KN, Farias RP, Fernandes AP, Fernandes GW, Ferrante M, Finn A, Florjancic GA, Forister ML, Fox QN, Frago E, França FM, Getman-Pickering AS, Getman-Pickering Z, Gianoli E, Gooden B, Gossner MM, Greig KA, Gripenberg S, Groenteman R, Grof-Tisza P, Haack N, Hahn L, Haq SM, Helms AM, Hennecke J, Hermann SL, Holeski LM, Holm S, Hutchinson MC, Jackson EE, Kagiya S, Kalske A, Kalwajtys M, Karban R, Kariyat R, Keasar T, Kersch-Becker MF, Kharouba HM, Kim TN, Kimuyu DM, Kluse J, Koerner SE, Komatsu KJ, Krishnan S, Laihonen M, Lamelas-López L, LaScaleia MC, Lecomte N, Lehn CR, Li X, Lindroth RL, LoPresti EF, Losada M, Louthan AM, Luizzi VJ, Lynch SC, Lynn JS, Lyon NJ, Maia LF, Maia RA, Mannall TL, Martin BS, Massad TJ, McCall AC, McGurrin K, Merwin AC, Mijango-Ramos Z, Mills CH, Moles AT, Moore CM, Moreira X, Morrison CR, Moshobane MC, Muola A, Nakadai R, Nakajima K, Novais S, Ogbebor CO, Ohsaki H, Pan VS, Pardikes NA, Pareja M, Parthasarathy N, Pawar RR, Paynter Q, Pearse IS, Penczykowski RM, Pepi AA, Pereira CC, Phartyal SS, Piper FI, Poveda K, Pringle EG, Puy J, Quijano T, Quintero C, Rasmann S, Rosche C, Rosenheim LY, Rosenheim JA, Runyon JB, Sadeh A, Sakata Y, Salcido DM, Salgado-Luarte C, Santos BA, Sapir Y, Sasal Y, Sato Y, Sawant M, Schroeder H, Schumann I, Segoli M, Segre H, Shelef O, Shinohara N, Singh RP, Smith DS, Sobral M, Stotz GC, Tack AJM, Tayal M, Tooker JF, Torrico-Bazoberry D, Tougeron K, Trowbridge AM, Utsumi S, Uyi O, Vaca-Uribe JL, Valtonen A, van Dijk LJA, Vandvik V, Villellas J, Waller LP, Weber MG, Yamawo A, Yim S, Zarnetske PL, Zehr LN, Zhong Z, Wetzel WC. Plant size, latitude, and phylogeny explain within-population variability in herbivory. Science 2023; 382:679-683. [PMID: 37943897 DOI: 10.1126/science.adh8830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 09/27/2023] [Indexed: 11/12/2023]
Abstract
Interactions between plants and herbivores are central in most ecosystems, but their strength is highly variable. The amount of variability within a system is thought to influence most aspects of plant-herbivore biology, from ecological stability to plant defense evolution. Our understanding of what influences variability, however, is limited by sparse data. We collected standardized surveys of herbivory for 503 plant species at 790 sites across 116° of latitude. With these data, we show that within-population variability in herbivory increases with latitude, decreases with plant size, and is phylogenetically structured. Differences in the magnitude of variability are thus central to how plant-herbivore biology varies across macroscale gradients. We argue that increased focus on interaction variability will advance understanding of patterns of life on Earth.
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Affiliation(s)
- M L Robinson
- Department of Entomology, Michigan State University, East Lansing, MI, USA
- Department of Biology, Utah State University, Logan, UT, USA
| | - P G Hahn
- Entomology and Nematology Department, University of Florida, Gainesville, FL, USA
| | - B D Inouye
- Department of Biological Science, Florida State University, Tallahassee, FL, USA
| | - N Underwood
- Department of Biological Science, Florida State University, Tallahassee, FL, USA
| | - S R Whitehead
- Department of Biological Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - K C Abbott
- Department of Biology, Case Western Reserve University, Cleveland, OH, USA
| | - E M Bruna
- Center for Latin American Studies, University of Florida, Gainesville, FL, USA
- Department of Wildlife Ecology and Conservation, University of Florida, Gainesville, FL, USA
| | - N I Cacho
- Instituto de Biología, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - L A Dyer
- Biology Department, University of Nevada, Reno, Reno, NV, USA
| | - L Abdala-Roberts
- Departamento de Ecología Tropical, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - W J Allen
- Bio-Protection Research Centre, University of Canterbury, Christchurch, New Zealand
| | - J F Andrade
- Departamento de Sistemática e Ecologia Universidade Federal da Paraíba, João Pessoa, Brazil
| | - D F Angulo
- Centro de Investigación Científica de Yucatán, Departamento de Recursos Naturales, Mérida, Yucatán, México
| | - D Anjos
- Instituto de Biologia, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
| | - D N Anstett
- Department of Entomology, Michigan State University, East Lansing, MI, USA
- Plant Resilience Institute, Michigan State University, East Lansing, MI, USA
- Department of Plant Biology, Michigan State University, East Lansing, MI, USA
| | - R Bagchi
- Department of Ecology and Evolutionary Biology, University of Connecticut, Storrs, CT, USA
| | - S Bagchi
- Centre for Ecological Sciences, Indian Institute of Science, Bangalore, Karnataka, India
| | - M Barbosa
- Department of Genetics, Ecology and Evolution, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - S Barrett
- Department of Biodiversity Conservation & Attractions Western Australia, Albany, Western Australia, Australia
| | - C A Baskett
- Institute of Science and Technology Austria, Klosterneuburg, Austria
| | - E Ben-Simchon
- Department of Natural Resources, Institute of Plant Sciences, Agricultural Research Organization - Volcani Institute, Rishon Le Tzion, Israel
- Robert H. Smith Faculty of Agriculture, Food, and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
| | - K J Bloodworth
- Department of Biology, University of North Carolina Greensboro, Greensboro, NC, USA
| | - J L Bronstein
- Department of Ecology and Evolutionary Biology, University of Arizona, Tucson, AZ, USA
| | - Y M Buckley
- School of Natural Sciences, Zoology, Trinity College Dublin, Dublin, Ireland
| | - K T Burghardt
- Department of Entomology, University of Maryland, College Park, MD, USA
| | - C Bustos-Segura
- Institute of Biology, University of Neuchatel, Neuchatel, Switzerland
| | - E S Calixto
- Entomology and Nematology Department, University of Florida, Gainesville, FL, USA
| | - R L Carvalho
- Institute of Advanced Studies, University of São Paulo, São Paulo, Brazil
| | | | - M C Chiuffo
- Grupo de Ecología de Invasiones, INIBIOMA, Universidad Nacional del Comahue, CONICET, San Carlos de Bariloche, Río Negro, Argentina
| | - D Cinoğlu
- Department of Integrative Biology, The University of Texas at Austin, Austin, TX, USA
| | - E Cinto Mejía
- Department of Entomology, Michigan State University, East Lansing, MI, USA
| | - M C Cock
- Facultad de Ciencias Exactas y Naturales, Instituto de Ciencias de la Tierra y Ambientales de La Pampa, Santa Rosa, La Pampa, Argentina
| | - R Cogni
- Department of Ecology, University of São Paulo, São Paulo, Brazil
| | - O L Cope
- Department of Entomology, Michigan State University, East Lansing, MI, USA
- Department of Biology, Whitworth University, Spokane, WA, USA
| | - T Cornelissen
- Department of Genetics, Ecology and Evolution, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - D R Cortez
- Department of Biology, California State University San Bernardino, San Bernardino, CA, USA
| | - D W Crowder
- Department of Entomology, Washington State University, Pullman, WA, USA
| | - C Dallstream
- Department of Biology, McGill University, Montreal, Quebec, Canada
| | - W Dáttilo
- Red de Ecoetología, Instituto de Ecología AC, Xalapa, Veracruz, Mexico
| | - J K Davis
- Department of Entomology, Cornell University, Ithaca, NY, USA
| | - R D Dimarco
- Department of Biology and Biochemistry, University of Houston, Houston, TX, USA
- Grupo de Ecología de Poblaciones de Insectos, IFAB, San Carlos de Bariloche, Río Negro, Argentina
| | - H E Dole
- Department of Entomology, Michigan State University, East Lansing, MI, USA
| | - I N Egbon
- Department of Animal and Environmental Biology, University of Benin, Benin City, Nigeria
| | - M Eisenring
- Forest Entomology, Swiss Federal Research Institute WSL, Birmensdorf, Switzerland
| | - A Ejomah
- Department of Animal and Environmental Biology, University of Benin, Benin City, Nigeria
| | - B D Elderd
- Department of Biological Sciences, Louisiana State University, Baton Rouge, LA, USA
| | - M-J Endara
- Grupo de Investigación en Ecología y Evolución en los Trópicos-EETROP, Universidad de las Américas, Quito, Ecuador
| | - M D Eubanks
- Department of Entomology, Texas A&M University, College Station, TX, USA
| | - S E Everingham
- Institute of Plant Sciences, University of Bern, Bern, Switzerland
- Evolution & Ecology Research Centre, University of New South Wales Sydney, Sydney, Australia
| | - K N Farah
- Department of Biology, Washington University in St. Louis, St. Louis, MO, USA
| | - R P Farias
- Instituto de Biologia, Universidade Federal da Bahia, Salvador, Bahia, Brasil
| | - A P Fernandes
- Department of Botany, Ganpat Parsekar College of Education Harmal, Pernem, Goa, India
| | - G W Fernandes
- Department of Genetics, Ecology and Evolution, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Knowledge Center for Biodiversity, Brazil
| | - M Ferrante
- Faculty of Agricultural Sciences and Environment, University of the Azores, Ponta Delgada, Portugal
- Department of Crop Sciences, University of Göttingen, Göttingen, Germany
| | - A Finn
- School of Natural Sciences, Zoology, Trinity College Dublin, Dublin, Ireland
| | - G A Florjancic
- Department of Biological Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - M L Forister
- Biology Department, University of Nevada, Reno, Reno, NV, USA
| | - Q N Fox
- Department of Biology, Washington University in St. Louis, St. Louis, MO, USA
| | - E Frago
- CIRAD, UMR CBGP, INRAE, Institut Agro, IRD, Université Montpellier, Montpellier, France
| | - F M França
- School of Biological Sciences, University of Bristol, Bristol, UK
- Programa de Pós-Graduação em Ecologia, Universidade Federal do Pará, Belém, Pará, Brasil
| | | | - Z Getman-Pickering
- Department of Mechanical and Industrial Engineering, University of Massachusetts Amherst, Amherst, MA, USA
| | - E Gianoli
- Departamento de Biología, Universidad de La Serena, La Serena, Chile
| | - B Gooden
- CSIRO Black Mountain Laboratories, CSIRO Health and Biosecurity, Canberra, Australia
| | - M M Gossner
- Forest Entomology, Swiss Federal Research Institute WSL, Birmensdorf, Switzerland
- Institute of Terrestrial Ecosystems, Department of Environmental Systems Science, ETH Zurich, Zurich, Switzerland
| | - K A Greig
- Department of Integrative Biology, The University of Texas at Austin, Austin, TX, USA
| | - S Gripenberg
- School of Biological Sciences, University of Reading, Reading, UK
| | - R Groenteman
- Manaaki Whenua - Landcare Research, Lincoln, New Zealand
| | - P Grof-Tisza
- Institute of Biology, University of Neuchatel, Neuchatel, Switzerland
| | - N Haack
- Independent Institute for Environmental Issues, Halle, Germany
| | - L Hahn
- Molecular Evolution and Systematics of Animals, University of Leipzig, Leipzig, Germany
| | - S M Haq
- Wildlife Crime Control Division, Wildlife Trust of India, Noida, Uttar Pradesh, India
| | - A M Helms
- Department of Entomology, Texas A&M University, College Station, TX, USA
| | - J Hennecke
- Systematic Botany and Functional Biodiversity, Leipzig University, Leipzig, Germany
- German Centre for Integrative Biodiversity Research (iDiv), Leipzig, Germany
| | - S L Hermann
- Department of Entomology, The Pennsylvania State University, University Park, PA, USA
| | - L M Holeski
- Department of Biological Sciences and Center for Adaptive Western Landscapes, Northern Arizona University, Flagstaff, AZ, USA
| | - S Holm
- Department of Environmental and Biological Sciences, University of Eastern Finland, Joensuu, Finland
- Department of Zoology, University of Tartu, Tartu, Estonia
| | - M C Hutchinson
- Department of Life and Environmental Sciences, University of California, Merced, Merced, CA, USA
| | - E E Jackson
- School of Biological Sciences, University of Reading, Reading, UK
| | - S Kagiya
- Field Science Center for Northern Biosphere, Hokkaido University, Sapporo, Hokkaido, Japan
| | - A Kalske
- Department of Biology, University of Turku, Turku, Finland
| | - M Kalwajtys
- Department of Entomology, Michigan State University, East Lansing, MI, USA
| | - R Karban
- Department of Entomology and Nematology, University of California Davis, Davis, CA, USA
| | - R Kariyat
- Department of Entomology and Plant Pathology, University of Arkansas, Fayetteville, AR, USA
| | - T Keasar
- Department of Biology and the Environment, University of Haifa - Oranim, Oranim, Tivon, Israel
| | - M F Kersch-Becker
- Department of Entomology, The Pennsylvania State University, University Park, PA, USA
| | - H M Kharouba
- Department of Biology, University of Ottawa, Ottawa, Ontario, Canada
| | - T N Kim
- Department of Entomology, Kansas State University, Manhattan, KS, USA
| | - D M Kimuyu
- Department of Natural Resources, Karatina University, Karatina, Kenya
| | - J Kluse
- Department of Biological Sciences, Louisiana State University, Baton Rouge, LA, USA
| | - S E Koerner
- Department of Biology, University of North Carolina Greensboro, Greensboro, NC, USA
| | - K J Komatsu
- Department of Biology, University of North Carolina Greensboro, Greensboro, NC, USA
- Smithsonian Environmental Research Center, Edgewater, MD, USA
| | - S Krishnan
- Center for Sustainable Future, Amrita University and EIACP RP, Amrita Viswa Vidyapeetham, Coimbatore, India
| | - M Laihonen
- Biodiversity Unit, University of Turku, Turku, Finland
| | - L Lamelas-López
- Faculty of Agricultural Sciences and Environment, University of the Azores, Ponta Delgada, Portugal
| | - M C LaScaleia
- Department of Ecology and Evolutionary Biology, University of Connecticut, Storrs, CT, USA
| | - N Lecomte
- Canada Research Chair in Polar and Boreal Ecology, Department of Biology and Centre d'Études Nordiques, Université de Moncton, Moncton, Canada
| | - C R Lehn
- Biological Sciences Course, Instituto Federal Farroupilha, Panambi, RS, Brazil
| | - X Li
- College of Resources and Environmental sciences, Jilin Agricultural University, Changchun, China
| | - R L Lindroth
- Department of Entomology, University of Wisconsin-Madison, Madison, WI, USA
| | - E F LoPresti
- Department of Biological Sciences, University of South Carolina, Columbia, SC, USA
| | - M Losada
- Department of Soil Science and Agricultural Chemistry, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - A M Louthan
- Division of Biology, Kansas State University, Manhattan, KS, USA
| | - V J Luizzi
- Department of Ecology and Evolutionary Biology, University of Arizona, Tucson, AZ, USA
| | - S C Lynch
- Division of Biology, Kansas State University, Manhattan, KS, USA
| | - J S Lynn
- Department of Biological Sciences, University of Bergen, Bergen, Norway
- Department of Earth and Environmental Sciences, University of Manchester, Manchester, UK
| | - N J Lyon
- Department of Entomology, Michigan State University, East Lansing, MI, USA
| | - L F Maia
- Bio-Protection Research Centre, University of Canterbury, Christchurch, New Zealand
- School of Biological Sciences, University of Bristol, Bristol, UK
| | - R A Maia
- Department of Genetics, Ecology and Evolution, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - T L Mannall
- Institute of Plant Sciences, University of Bern, Bern, Switzerland
| | - B S Martin
- Department of Plant Biology, Michigan State University, East Lansing, MI, USA
- Ecology, Evolution, and Behavior Program, Michigan State University, East Lansing, MI, USA
| | - T J Massad
- Department of Scientific Services, Gorongosa National Park, Sofala, Mozambique
| | - A C McCall
- Biology Department, Denison University, Granville, OH, USA
| | - K McGurrin
- Department of Entomology, University of Maryland, College Park, MD, USA
| | - A C Merwin
- Department of Biology and Geology, Baldwin Wallace University, Berea, OH, USA
| | - Z Mijango-Ramos
- Department of Integrative Biology, The University of Texas at Austin, Austin, TX, USA
| | - C H Mills
- Evolution & Ecology Research Centre, University of New South Wales Sydney, Sydney, Australia
| | - A T Moles
- Evolution & Ecology Research Centre, University of New South Wales Sydney, Sydney, Australia
| | - C M Moore
- Department of Biology, Colby College, Waterville, ME, USA
| | - X Moreira
- Misión Biológica de Galicia, Consejo Superior de Investigaciones Científicas, Pontevedra, Galicia, Spain
| | - C R Morrison
- Department of Integrative Biology, The University of Texas at Austin, Austin, TX, USA
| | - M C Moshobane
- South African National Biodiversity Institute, Pretoria National Botanical Garden, Brummeria, Silverton, South Africa
- Centre for Functional Biodiversity, University of KwaZulu-Natal, Scottsville, Pietermaritzburg, South Africa
| | - A Muola
- Division of Biotechnology and Plant Health, Norwegian Institute of Bioeconomy Research, Tromsø, Norway
| | - R Nakadai
- Faculty of Environment and Information Sciences, Yokohama National University, Yokohama, Kanagawa, Japan
| | - K Nakajima
- Insitute of Science and Engineering, Chuo University, Tokyo, Japan
- Institute of Cave Research, Shimohei-guun, Iwate Prefecture, Japan
| | - S Novais
- Red de Interacciones Multitróficas, Instituto de Ecología A.C., Xalapa, Veracruz, Mexico
| | - C O Ogbebor
- Nigerian Institute for Oil Palm Research, Benin City, Edo State, Nigeria
| | - H Ohsaki
- Department of Biological Sciences, Hirosaki University, Hirosaki, Aomori, Japan
| | - V S Pan
- Ecology, Evolution, and Behavior Program, Michigan State University, East Lansing, MI, USA
- Department of Integrative Biology, Michigan State University, East Lansing, MI, USA
| | - N A Pardikes
- Department of Biology, Utah State University, Logan, UT, USA
| | - M Pareja
- Departamento de Biologia Animal, Universidade Estadual de Campinas, Campinas, Brazil
| | - N Parthasarathy
- Department of Ecology and Evironmental Sciences, Pondicherry University, Puducherry, India
| | | | - Q Paynter
- Manaaki Whenua - Landcare Research, Auckland, New Zealand
| | - I S Pearse
- U.S. Geological Survey, Fort Collins Science Center, Fort Collins, CO, USA
| | - R M Penczykowski
- Department of Biology, Washington University in St. Louis, St. Louis, MO, USA
| | - A A Pepi
- Department of Biology, Tufts University, Medford, MA, USA
| | - C C Pereira
- Department of Genetics, Ecology and Evolution, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - S S Phartyal
- School of Ecology & Environment Studies, Nalanda University, Rajgir, India
| | - F I Piper
- Millennium Nucleus of Patagonian Limit of Life and Instituto de Ciencias Biológicas, Universidad de Talca, Talca, Chile
- Institute of Ecology and Biodiversity, Ñuñoa, Santiago
| | - K Poveda
- Department of Entomology, Cornell University, Ithaca, NY, USA
| | - E G Pringle
- Biology Department, University of Nevada, Reno, Reno, NV, USA
| | - J Puy
- School of Natural Sciences, Zoology, Trinity College Dublin, Dublin, Ireland
- Estación Biológica de Doñana, Consejo Superior de Investigaciones Científicas, Sevilla, Spain
| | - T Quijano
- Departamento de Ecología Tropical, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - C Quintero
- INIBIOMA, CONICET - Universidad Nacional del Comahue, San Carlos de Bariloche, Río Negro, Argentina
| | - S Rasmann
- Institute of Biology, University of Neuchatel, Neuchatel, Switzerland
| | - C Rosche
- German Centre for Integrative Biodiversity Research (iDiv), Leipzig, Germany
- Institute of Geobotany and Botanical Garden, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - L Y Rosenheim
- Department of Entomology and Nematology, University of California Davis, Davis, CA, USA
| | - J A Rosenheim
- Department of Entomology and Nematology, University of California Davis, Davis, CA, USA
| | - J B Runyon
- Rocky Mountain Research Station, USDA Forest Service, Bozeman, MT, USA
| | - A Sadeh
- Department of Natural Resources, Newe Ya'ar Research Center, Volcani Institute, Ramat Yishay, Israel
| | - Y Sakata
- Department of Biological Environment, Akita Prefectural University, Shimoshinjyo-Nakano, Akita, Japan
| | - D M Salcido
- Biology Department, University of Nevada, Reno, Reno, NV, USA
| | - C Salgado-Luarte
- Instituto de Investigación Multidisciplinario en Ciencia y Tecnología, Universidad de La Serena, La Serena, Chile
| | - B A Santos
- Departamento de Sistemática e Ecologia Universidade Federal da Paraíba, João Pessoa, Brazil
| | - Y Sapir
- The Botanic Garden, School of Plant Sciences and Food Security, Faculty of Life Science, Tel Aviv University, Tel Aviv, Israel
| | - Y Sasal
- INIBIOMA, CONICET - Universidad Nacional del Comahue, San Carlos de Bariloche, Río Negro, Argentina
| | - Y Sato
- Department of Evolutionary Biology and Environmental Studies, University of Zurich, Zurich, Switzerland
| | - M Sawant
- Department of Ecology, University of Pune, Maharashtra, India
| | - H Schroeder
- Department of Entomology, Cornell University, Ithaca, NY, USA
| | - I Schumann
- Department of Human Genetics, University of Leipzig, Leipzig, Germany
| | - M Segoli
- Mitrani Department of Desert Ecology, Blaustein Institutes for Desert Research, Ben-Gurion University of the Negev, Midreshet Ben-Gurion, Israel
| | - H Segre
- Department of Natural Resources, Institute of Plant Sciences, Agricultural Research Organization - Volcani Institute, Rishon Le Tzion, Israel
- Robert H. Smith Faculty of Agriculture, Food, and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
- Department of Natural Resources, Newe Ya'ar Research Center, Volcani Institute, Ramat Yishay, Israel
| | - O Shelef
- Department of Natural Resources, Institute of Plant Sciences, Agricultural Research Organization - Volcani Institute, Rishon Le Tzion, Israel
| | - N Shinohara
- Graduate School of Life Sciences, Tohoku University, Sendai, Japan
| | - R P Singh
- McGuire Center for Lepidoptera and Biodiversity, Florida Museum of Natural History, University of Florida, Gainesville, FL, USA
| | - D S Smith
- Department of Biology, California State University San Bernardino, San Bernardino, CA, USA
| | - M Sobral
- Department of Soil Science and Agricultural Chemistry, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - G C Stotz
- Department of Plant and Environmental Sciences, Clemson University, Clemson, SC, USA
| | - A J M Tack
- Department of Ecology, Environment and Plant Sciences, Stockholm University, Stockholm, Sweden
| | - M Tayal
- Department of Plant and Environmental Sciences, Clemson University, Clemson, SC, USA
| | - J F Tooker
- Department of Entomology, The Pennsylvania State University, University Park, PA, USA
| | - D Torrico-Bazoberry
- Laboratorio de Comportamiento Animal y Humano, Centro de Investigación en Complejidad Social, Universidad del Desarrollo, Las Condes, Chile
| | - K Tougeron
- Écologie et Dynamique des Systèmes Anthropisés, Université de Picardie Jules Verne, UMR 7058 CNRS, Amiens, France
- Ecology of Interactions and Global Change, Institut de Recherche en Biosciences, Université de Mons, Mons, Belgium
| | - A M Trowbridge
- Department of Forest and Wildlife Ecology, University of Wisconsin, Madison, WI, USA
| | - S Utsumi
- Field Science Center for Northern Biosphere, Hokkaido University, Sapporo, Hokkaido, Japan
| | - O Uyi
- Department of Animal and Environmental Biology, University of Benin, Benin City, Nigeria
- Department of Entomology, University of Georgia, Tifton, GA, USA
| | - J L Vaca-Uribe
- Programa de ingeniría agroecológica, Corporación Universitaria Minuto de Dios, Bogotá, Colombia
| | - A Valtonen
- Department of Environmental and Biological Sciences, University of Eastern Finland, Joensuu, Finland
| | - L J A van Dijk
- Department of Ecology, Environment and Plant Sciences, Stockholm University, Stockholm, Sweden
- Department of Bioinformatics and Genetics, Swedish Museum of Natural History, Stockholm, Sweden
| | - V Vandvik
- Department of Biological Sciences, University of Bergen, Bergen, Norway
| | - J Villellas
- Department of Life Sciences, University of Alcalá, Madrid, Spain
| | - L P Waller
- Bioprotection Aotearoa, Lincoln University, Lincoln, New Zealand
| | - M G Weber
- Department of Ecology and Evolutionary Biology, University of Michigan, Ann Arbor, MI, USA
| | - A Yamawo
- Department of Biological Sciences, Hirosaki University, Hirosaki, Aomori, Japan
- Center for Ecological Research, Kyoto University, Otsu, Japan
| | - S Yim
- Biology Department, University of Nevada, Reno, Reno, NV, USA
| | - P L Zarnetske
- Ecology, Evolution, and Behavior Program, Michigan State University, East Lansing, MI, USA
- Department of Integrative Biology, Michigan State University, East Lansing, MI, USA
| | - L N Zehr
- Department of Entomology, Michigan State University, East Lansing, MI, USA
| | - Z Zhong
- Institute of Grassland Science, Key Laboratory of Vegetation Ecology, Ministry of Education/Jilin Songnen Grassland Ecosystem National Observation and Research Station, Northeast Normal University, Changchun, Jilin Province, China
- Institute of Plant Protection, Chinese Academy of Agricultural Sciences, State Key Laboratory for Biology of Plant Diseases and Insect Pests, Beijing, China
| | - W C Wetzel
- Department of Entomology, Michigan State University, East Lansing, MI, USA
- Plant Resilience Institute, Michigan State University, East Lansing, MI, USA
- Ecology, Evolution, and Behavior Program, Michigan State University, East Lansing, MI, USA
- Department of Integrative Biology, Michigan State University, East Lansing, MI, USA
- W.K. Kellogg Biological Station, Michigan State University, Hickory Corners, MI, USA
- Land Resources and Environmental Sciences, Montana State University, Bozeman, MT, USA
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Russell MW, Maatouk CM, Kim S, Liu B, Muste JC, Talcott KE, Singh RP. Lack of association between Lp(a) and retinal vein occlusion in a single institution and US national database. Can J Ophthalmol 2023:S0008-4182(23)00314-9. [PMID: 37935381 DOI: 10.1016/j.jcjo.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/24/2023] [Accepted: 10/04/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVE This study examines associations between lipoprotein(a) (Lp[a]), a low-density-like lipoprotein, and renal vein occlusion (RVO) in US cohorts to characterize its prognostic role in the setting of RVO. DESIGN A two-phase retrospective cohort study. METHODS In the first phase, patients with RVO and a Lp(a) quantitative laboratory value at a single tertiary centre were reviewed. Lp(a) status was assessed in association with age of RVO diagnosis, visual acuity, time to development of RVO, and central subfield thickness. In the second phase, the TriNetX US Collaborative Network, a large national database, also was queried for the presence of high or low Lp(a) values and diagnoses of RVO. RESULTS The single tertiary care centre identified 45 patients with RVO and a laboratory value of Lp(a), finding no significant associations with respect to Lp(a) status and age of RVO onset, time from the laboratory draw to the development of RVO, visual acuity, and central subfield thickness (p > 0.05 for all). The TriNetX national database identified 35,687 patients with a high Lp(a) value (>30 mg/dL or 61 nmol/L) and 51,692 with a low Lp(a) value. An elevated Lp(a) value was not associated with higher odds of central (odds ratio [OR] = 1.15; 95% CI, 0.88-1.50) or branch RVO (OR = 1.01; 95% CI, 0.76-1.36). CONCLUSION Taken together, this analysis suggests a lack of association between Lp(a) value and risk of RVO. This study highlights the benefit of large national databases in the validation of laboratory value predictors identified through small-cohort observational studies.
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Affiliation(s)
- Matthew W Russell
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH; Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH
| | - Christopher M Maatouk
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH; Case Western Reserve University School of Medicine, Cleveland, OH
| | - Suzie Kim
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH; Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH
| | - Brian Liu
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH; Case Western Reserve University School of Medicine, Cleveland, OH
| | | | | | - Rishi P Singh
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH; Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH; Cleveland Clinic Cole Eye Institute, Cleveland, OH; Martin North Hospital, Cleveland Clinic, Cleveland, OH.
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Chadalavada SH, Shaia JK, Russell MW, Talcott KE, Singh RP. Impact of Dyslipidemia Medications on the Prevalence of Diabetic Retinopathy Among a Large US Cohort. Ophthalmic Surg Lasers Imaging Retina 2023; 54:626-633. [PMID: 37956319 DOI: 10.3928/23258160-20231017-01] [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: 11/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Dyslipidemia medications such as statins and fibrates may be associated with a reduction in diabetic retinopathy (DR) progression, but real-world data is lacking. This study evaluates cholesterol-lowering medications and their association with the prevalence of DR and advanced DR complications. PATIENTS AND METHODS Data was collected using codes from the International Classification of Diseases on TriNetX, a cross-sectional database of over 79 million Americans, between June and August 2022. Prevalence and prevalence odds ratios (POR) were calculated. RESULTS Patients taking pitavastatin (OR 0.64, 95% CI 0.49, 0.84), fenofibrate (OR 0.83, CI 0.79, 0.87), or evolocumab (OR 0.80, CI 0.68, 0.95) had lower POR of proliferative DR compared to nonproliferative DR. Patients taking any cholesterol medication had a lower POR of vitreous hemorrhage. Patients taking fibrates also had lower POR of neovascular glaucoma. CONCLUSION This exploratory study highlights positive associations between DR and dyslipidemia and medications that may have fewer worsening events in DR patients. [Ophthalmic Surg Lasers Imaging Retina 2023;54:626-633.].
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Russell MW, Chalasani M, Rana N, Muste JC, Rachitskaya AV, Talcott KE, Singh RP, Sharma S. Effect of Prefilled vs Vial-Drawn Syringes on Sustained Increases in Intraocular Pressure in Patients Treated With Aflibercept. J Vitreoretin Dis 2023; 7:498-503. [PMID: 37974923 PMCID: PMC10649452 DOI: 10.1177/24741264231200735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Purpose: To evaluate the effect of syringe type on developing sustained intraocular pressure (IOP) increases. Methods: This retrospective cohort study included patients in a single academic center receiving antivascular endothelial growth factor (anti-VEGF) injections from 2012 to 2022 for various indications. Patients were grouped by anti-VEGF treatment of either vial-drawn or prefilled syringe delivery. Trends in IOP were recorded for 1 year after treatment began. Development of sustained IOP increase, ocular hypertension, and glaucoma was recorded. Sustained IOP increase was defined as ≥5 mm Hg above baseline for at least 4 weeks. Results: Of 257 total patients, 6 (2.3%) developed sustained IOP increases throughout the study's duration. No significant differences were noted with respect to prefilled versus vial-drawn syringe status on the development of sustained IOP increases or incident glaucoma (IOP: 1.8% vs 2.7%, respectively, P = .65; glaucoma: 0.0% vs 2.0%, respectively, P = .14). Patients treated with prefilled syringes were significantly less likely to develop ocular hypertension (2.8% vs 8.8%, P < .05). Conclusions: This study found that aflibercept intravitreal injection with prefilled syringes was not associated with a significant increase in IOP-related adverse effects when compared with those treated with vial-drawn syringes.
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Affiliation(s)
- Matthew W. Russell
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | | | - Neil Rana
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Justin C. Muste
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic, Cole Eye Institute, Cleveland, OH, USA
| | - Aleksandra V. Rachitskaya
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic, Cole Eye Institute, Cleveland, OH, USA
| | - Katherine E. Talcott
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic, Cole Eye Institute, Cleveland, OH, USA
| | - Rishi P. Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic, Cole Eye Institute, Cleveland, OH, USA
| | - Sumit Sharma
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic, Cole Eye Institute, Cleveland, OH, USA
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Weng CY, Singh RP, Gillies MC, Regillo CD. Optimizing Visual Outcomes in Patients With Neovascular Age-Related Macular Degeneration: the Potential Value of Sustained Anti-VEGF Therapy. Ophthalmic Surg Lasers Imaging Retina 2023; 54:654-659. [PMID: 37956321 DOI: 10.3928/23258160-20231016-01] [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: 11/15/2023]
Abstract
Neovascular age-related macular degeneration (nAMD) leads to irreversible central vision loss if untreated. Frequent administration of anti-vascular endothelial growth factor (anti-VEGF) injections inhibits disease activity with excellent functional and morphological benefits. However, these injections pose a heavy therapeutic burden, and treatment discontinuation is common. Although current anti-VEGF treatment paradigms, such as treat-and-extend, mitigate treatment burden while still leading to acceptable vision outcomes, they fail to sustain initial vision gains for many. Novel longer-acting anti-VEGF therapies may reduce the overall burden on nAMD patients. Gene therapy might offer a paradigm shift by providing continuous expression of anti-VEGF, potentially decreasing treatment requirements and improving long-term vision outcomes. [Ophthalmic Surg Lasers Imaging Retina 2023;54:654-659.].
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Heier JS, Lad EM, Holz FG, Rosenfeld PJ, Guymer RH, Boyer D, Grossi F, Baumal CR, Korobelnik JF, Slakter JS, Waheed NK, Metlapally R, Pearce I, Steinle N, Francone AA, Hu A, Lally DR, Deschatelets P, Francois C, Bliss C, Staurenghi G, Monés J, Singh RP, Ribeiro R, Wykoff CC. Pegcetacoplan for the treatment of geographic atrophy secondary to age-related macular degeneration (OAKS and DERBY): two multicentre, randomised, double-masked, sham-controlled, phase 3 trials. Lancet 2023; 402:1434-1448. [PMID: 37865470 DOI: 10.1016/s0140-6736(23)01520-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [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: 03/17/2023] [Revised: 07/10/2023] [Accepted: 07/19/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Geographic atrophy is a leading cause of progressive, irreversible vision loss. The objectives of OAKS and DERBY were to assess the efficacy and safety of pegcetacoplan compared with sham treatment in patients with geographic atrophy. METHODS OAKS and DERBY were two 24-month, multicentre, randomised, double-masked, sham-controlled, phase 3 studies, in which patients aged 60 years and older with geographic atrophy secondary to age-related macular degeneration were enrolled at 110 clinical sites and 122 clinical sites worldwide, respectively. Patients were randomly assigned (2:2:1:1) by central web-based randomisation system to intravitreal 15 mg per 0·1 mL pegcetacoplan monthly or every other month, or sham monthly or every other month using stratified permuted block randomisation (stratified by geographic atrophy lesion area at screening, history or presence of active choroidal neovascularisation in the eye not under assessment, and block size of six). Study site staff, patients, reading centre personnel, evaluating physicians, and the funder were masked to group assignment. Sham groups were pooled for the analyses. The primary endpoint was the change from baseline to month 12 in the total area of geographic atrophy lesions in the study eye based on fundus autofluorescence imaging, in the modified intention-to-treat population (ie, all patients who received one or more injections of pegcetacoplan or sham and had a baseline and at least one post-baseline value of lesion area). Key secondary endpoints (measured at 24 months) were change in monocular maximum reading speed of the study eye, change from baseline in mean functional reading independence index score, change from baseline in normal luminance best-corrected visual acuity score, and change from baseline in the mean threshold sensitivity of all points in the study eye by mesopic microperimetry (OAKS only). Safety analyses included patients who were randomly assigned and received at least one injection of pegcetacoplan or sham. The now completed studies are registered with ClinicalTrials.gov, NCT03525613 (OAKS) and NCT03525600 (DERBY). FINDINGS Between Aug 30, 2018, and July 3, 2020, 1258 patients were enrolled in OAKS and DERBY. The modified intention-to-treat populations comprised 614 (96%) of 637 patients in OAKS (202 receiving pegcetacoplan monthly, 205 pegcetacoplan every other month, and 207 sham) and 597 (96%) of 621 patients in DERBY (201 receiving pegcetacoplan monthly, 201 pegcetacoplan every other month, and 195 sham). In OAKS, pegcetacoplan monthly and pegcetacoplan every other month significantly slowed geographic atrophy lesion growth by 21% (absolute difference in least-squares mean -0·41 mm2, 95% CI -0·64 to -0·18; p=0·0004) and 16% (-0·32 mm2, -0·54 to -0·09; p=0·0055), respectively, compared with sham at 12 months. In DERBY, pegcetacoplan monthly and pegcetacoplan every other month slowed geographic atrophy lesion growth, although it did not reach significance, by 12% (-0·23 mm2, -0·47 to 0·01; p=0·062) and 11% (-0·21 mm2, -0·44 to 0·03; p=0·085), respectively, compared with sham at 12 months. At 24 months, pegcetacoplan monthly and pegcetacoplan every other month slowed geographic atrophy lesion growth by 22% (-0·90 mm2, -1·30 to -0·50; p<0·0001) and 18% (-0·74 mm2, -1·13 to -0·36; p=0·0002) in OAKS, and by 19% (-0·75 mm2, -1·15 to -0·34; p=0·0004) and 16% (-0·63 mm2, -1·05 to -0·22; p=0·0030) in DERBY, respectively, compared with sham. There were no differences in key secondary visual function endpoints at 24 months. Serious ocular treatment-emergent adverse events were reported in five (2%) of 213, four (2%) of 212, and one (<1%) of 211 patients in OAKS, and in four (2%) of 206, two (1%) of 208, and two (1%) of 206 patients in DERBY receiving pegcetacoplan monthly, pegcetacoplan every other month, and sham, respectively, at 24 months. New-onset exudative age-related macular degeneration was reported in 24 (11%), 16 (8%), and four (2%) patients in OAKS, and in 27 (13%), 12 (6%), and nine (4%) patients in DERBY receiving pegcetacoplan monthly, pegcetacoplan every other month, and sham, respectively, at 24 months. INTERPRETATION Pegcetacoplan, the first treatment approved by the US Food and Drug Administration for geographic atrophy, slowed geographic atrophy lesion growth with an acceptable safety profile. FUNDING Apellis Pharmaceuticals.
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Affiliation(s)
| | - Eleonora M Lad
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
| | - David Boyer
- Retina Vitreous Associates Medical Group, Los Angeles, CA, USA
| | | | | | - Jean-Francois Korobelnik
- Service d'Ophtalmologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Ophthalmology Department, University of Bordeaux, Bordeaux, France
| | - Jason S Slakter
- Department of Ophthalmology, New York University, New York, NY, USA
| | | | | | - Ian Pearce
- Department of Ophthalmology, Royal Liverpool University Hospital, Liverpool, UK
| | | | | | - Allen Hu
- Cumberland Valley Retina Consultants, Hagerstown, MD, USA
| | - David R Lally
- New England Retina Consultants, Springfield, MA, USA
| | | | | | | | - Giovanni Staurenghi
- Department of Biomedical and Clinical Science, Ospedale Luigi Sacco University of Milan, Milan, Italy
| | - Jordi Monés
- Institut de la Màcula, Centro Médico Teknon, Barcelona, Spain; Barcelona Macula Foundation: Research for Vision, Barcelona, Spain
| | - Rishi P Singh
- Center for Ophthalmic Bioinformatics, Cleveland Clinic, Cleveland, OH, USA
| | | | - Charles C Wykoff
- Retina Consultants of Texas, Houston, TX, USA; Blanton Eye Institute, Houston, TX, USA; Houston Methodist Hospital, Houston, TX, USA.
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Singh RP, Amoaku W, Bandello F, Chen FK, Holz FG, Kodjikian L, Ruiz-Moreno JM, Joshi P, Wykoff CC. Diagnosis and Management of Patients With Geographic Atrophy Secondary to Age-Related Macular Degeneration: A Delphi Consensus Exercise. Ophthalmic Surg Lasers Imaging Retina 2023; 54:589-598. [PMID: 37847167 DOI: 10.3928/23258160-20230824-01] [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: 10/18/2023]
Abstract
Geographic atrophy (GA) is a progressive and irreversible retinal disease with no comprehensive recommendations for diagnosis or monitoring. We used a Delphi approach to determine consensus in key areas around diagnosis and management of GA. A steering committee of eight retina specialists developed two sequential online surveys administered to eye care professionals (ECPs). Consensus was defined as agreement by ≥ 75% of respondents. Up to 177 ECPs from eight countries completed one or both surveys. Consensus was achieved in several topics related to diagnostic imaging, including the use of optical coherence tomography, and the urgent need for treatments and beneficial interventions to reduce the associated burden. Currently, low-vision aids and smoking cessation are considered the most beneficial interventions. We demonstrate consensus for diagnosis and management of patients with GA including best practices in patient identification and monitoring, and unmet needs. [Ophthalmic Surg Lasers Imaging Retina 2023;54:589-598.].
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Russell MW, Muste JC, Kuo BL, Wu AK, Singh RP. Clinical trials targeting the gut-microbiome to effect ocular health: a systematic review. Eye (Lond) 2023; 37:2877-2885. [PMID: 36918627 PMCID: PMC10516887 DOI: 10.1038/s41433-023-02462-7] [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: 03/25/2022] [Revised: 11/21/2022] [Accepted: 02/21/2023] [Indexed: 03/16/2023] Open
Abstract
Clinical trials targeting the gut microbiome to mitigate ocular disease are now on the horizon. A review of clinical data thus far is essential to determine future directions in this novel promising field. This review examines recent clinical trials that support the plausibility of a gut-eye axis, and may form the basis of novel clinical interventions. PubMed was queried for English language clinical studies examining the relationships between gut microbiota and ocular pathology. 25 studies were extracted from 828 candidate publications, which suggest that gut imbalance is associated with ocular pathology. Of these, only four interventional studies exist which suggest probiotic supplementation or fecal microbiota transplant can reduce symptoms of chalazion or uveitis. The gut-eye axis appears to hold clinical relevance, but current data is limited in sample size and design. Further investigation via longitudinal clinical trials may be warranted.
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Affiliation(s)
- Matthew W Russell
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Justin C Muste
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Blanche L Kuo
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Anna K Wu
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Rishi P Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA.
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Salehi MA, Rezagholi F, Mohammadi S, Zakavi SS, Jahanshahi A, Gouravani M, Yazdanpanah G, Seddon I, Jabbehdari S, Singh RP. Optical coherence tomography angiography measurements in Parkinson's disease: A systematic review and meta-analysis. Eye (Lond) 2023; 37:3145-3156. [PMID: 36941403 PMCID: PMC10564940 DOI: 10.1038/s41433-023-02483-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 01/06/2023] [Accepted: 02/28/2023] [Indexed: 03/23/2023] Open
Abstract
Optical coherence tomography angiography (OCT-A) is an ocular imaging technology that has emerged as a non-invasive tool to evaluate retinal microvascular changes in neurodegenerative diseases including Parkinson's disease (PD) and Alzheimer's disease. While several studies have reported on the presence of pathologic retinal microvascular alterations in PD, the utility of OCT-A as a biomarker for PD evaluation is still unclear. A systematic review and meta-analysis were performed to explore the current evidence for the role of OCT-A in PD published up until June 2022. PubMed, Scopus, and Web of Science databases were used to systematically identify relevant papers and a meta-analysis was conducted using Stata16 software according to the level of heterogeneity applying a random- or fixed-effect model. Thirteen studies of 925 eyes in the PD group and 1501 eyes in the control group assessing OCT-A findings in PD patients were included. The meta-analyses revealed that the foveal region of PD patients had a significantly lower vessel density in the superficial capillary plexus (SCP) compared to healthy controls but that there were no significant differences in the foveal avascular zone, the SCP in whole, parafoveal, and perifoveal regions, and deep capillary plexus. OCT-A metrics may act as a potential biomarker for a more accurate and early PD diagnosis. Still, the OCT-A algorithms and interchangeability between OCT-A devices require further standardization to draw clinical conclusions regarding their utility.
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Affiliation(s)
| | - Fateme Rezagholi
- School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Soheil Mohammadi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Sina Zakavi
- School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Jahanshahi
- School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mahdi Gouravani
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghasem Yazdanpanah
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
| | - Ian Seddon
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Sayena Jabbehdari
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Rishi P Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA.
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Liu JC, Vatti T, Seth K, Valentim CCS, Rachitskaya AV, Singh RP. Outcomes in patients with retinal vein occlusion with good baseline visual acuity. Eye (Lond) 2023; 37:3203-3208. [PMID: 36949245 PMCID: PMC10564869 DOI: 10.1038/s41433-023-02488-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 01/13/2023] [Accepted: 03/02/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) are first-line therapy for macular oedema in retinal vein occlusion (RVO). Appropriate management for RVO with good visual acuity at diagnosis has not been evaluated. The purpose of this study is to analyse the visual and anatomic outcomes from anti-VEGF treatment among RVO patients with good vision at baseline. METHODS This retrospective cohort study evaluated patients diagnosed with macular oedema secondary to RVO from January 2012 to February 2021 at a tertiary ophthalmic centre. Patients had a Snellen acuity of 20/32 or better at diagnosis. Three cohorts were compared: patients with no anti-VEGF treatment, delayed anti-VEGF treatment (initial injection >30 days post-diagnosis) and immediate anti-VEGF treatment (initial injection ≤30 days post-diagnosis). Central subfield thickness (CST) and best visual acuity (BVA) were collected at diagnosis and 6-, 12- and 24-month follow-up appointments. RESULTS Among 131 eyes, mean BVA values among treatment groups did not differ at 6-, 12- or 24-month follow up visits (P = 0.521, 0.426, 0.356, respectively). The percentage of eyes with at least a 5-letter BVA decrease at 24 months was 24.1%, 65.0% and 30.8% in the no treatment, delayed and immediate treatment groups respectively (P = 0.010). There was no significant difference in the percentage of eyes with at least a 10% decrease in CST at 24 months among groups (P = 0.095). CONCLUSIONS Close observation with initiation of treatment in patients with good visual acuity with macular oedema secondary to RVO as indicated has similar outcomes in the setting of routine clinical practice.
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Affiliation(s)
- Jessica C Liu
- Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Thanvi Vatti
- Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Kanika Seth
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Carolina C S Valentim
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Aleksandra V Rachitskaya
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Rishi P Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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Salehi MA, Rezagholi F, Mohammadi S, Zakavi SS, Jahanshahi A, Gouravani M, Yazdanpanah G, Seddon I, Jabbehdari S, Singh RP. Correction: Optical coherence tomography angiography measurements in Parkinson's disease: a systematic review and meta-analysis. Eye (Lond) 2023; 37:3298. [PMID: 37714993 PMCID: PMC10564717 DOI: 10.1038/s41433-023-02691-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Affiliation(s)
| | - Fateme Rezagholi
- School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Soheil Mohammadi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Sina Zakavi
- School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Jahanshahi
- School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mahdi Gouravani
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghasem Yazdanpanah
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
| | - Ian Seddon
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Sayena Jabbehdari
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Rishi P Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA.
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Maatouk CM, Liu JC, Alsaloum P, Iyer AI, Kaiser PM, Singh RP, Talcott KE. Predictors of response to a lapse in anti-VEGF treatment in patients with macular edema secondary to retinal vein occlusion. Can J Ophthalmol 2023:S0008-4182(23)00250-8. [PMID: 37716706 DOI: 10.1016/j.jcjo.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/08/2023] [Accepted: 08/11/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Macular edema (ME) in the setting of retinal vein occlusions (RVO) is a common cause of vision loss worldwide. Anti-vascular endothelial growth factor (anti-VEGF) injections are the gold standard for ME secondary to RVO. Despite their efficacy, anti-VEGF injections carry significant burdens for patients, resulting in high rates of loss to follow-up and treatment lapses. METHODS A sub-analysis examining the effects of a treatment lapse in RVO patients was conducted. Sixty patients were included and separated into vision-loss and stable-vision groups based on change in vision after a lapse. A logistic regression with age, body mass index (BMI), history of dyslipidemia, and time since diagnosis of RVO as predictors was used to predict whether patients would experience vision loss after a lapse. RESULTS The average lapse was 5.6 months and similar in the vision-loss and stable-vision groups. At baseline, the vision-loss group was older and had a lower BMI (p < 0.05). Age and history of dyslipidemia increased the odds of vision loss by factors of 1.23 (range, 1.10-1.45) and 8.40 (range, 1.62-66.2), respectively. BMI and time since RVO diagnosis decreased the odds of vision loss by factors of 0.83 (range, 0.69-0.95) and 0.95 (range, 0.90-0.99), respectively. The final model had a specificity of 87.5% and a sensitivity of 70.0%. CONCLUSIONS Patients' responses to treatment lapses for ME secondary to RVO can be predicted with reasonable accuracy using readily available clinical data, particularly age, BMI, time since diagnosis, and history of dyslipidemia. Providers should consider these factors when counselling patients and determining follow-up schedules.
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Affiliation(s)
- Christopher M Maatouk
- Case Western Reserve University School of Medicine, Cleveland, Ohio; Center for Ophthalmic Bioinformatics, Cleveland Clinic, Foundation, Cleveland, Ohio
| | - Jessica C Liu
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Peter Alsaloum
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Amogh I Iyer
- Center for Ophthalmic Bioinformatics, Cleveland Clinic, Foundation, Cleveland, Ohio; The Ohio State University College of Medicine, Columbus, Ohio
| | | | - Rishi P Singh
- Center for Ophthalmic Bioinformatics, Cleveland Clinic, Foundation, Cleveland, Ohio; Cleveland Clinic Martin Health, Stuart, Fla
| | - Katherine E Talcott
- Center for Ophthalmic Bioinformatics, Cleveland Clinic, Foundation, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
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Alsaloum P, Russell MW, Blaga V, Kuo BL, Wu AK, Liu BJ, Valentim CCS, Xu CM, Muste JC, Kumar M, Singh RP. Time to fellow eye involvement in patients with unilateral diabetic macular oedema. Eye (Lond) 2023; 37:2761-2767. [PMID: 36732545 PMCID: PMC10482824 DOI: 10.1038/s41433-023-02410-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/23/2022] [Accepted: 01/16/2023] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To examine the time to onset of disease in the fellow eye of patients with unilateral DMO in routine clinical practice and to identify risk factors for development of bilateral DMO. DESIGN Retrospective cohort study. PARTICIPANTS One hundred forty treatment-naive patients 18 years or older with unilateral DMO presenting to Cole Eye Institute between January 2012 and July 2021. METHODS Records of patients with unilateral DMO were reviewed for development of DMO in the fellow eye. Demographic, diabetic, ocular, and systemic characteristics were collected at initial DMO diagnosis date. Bivariate and multivariate analyses were performed and significant factors were modelled using Kaplan-Meier curves. RESULTS Fifty patients with conversion to bilateral DMO and 90 patients without conversion were identified. Average time to bilateral DMO was 15.0 ± 15.7 months. 64% of patients converted within 1 year and 90% converted within 3 years. HbA1c (p = 0.003), diabetic retinopathy duration (p = 0.029), and diabetic foot disease (DFD) (p = 0.002) were identified as significant risk factors for conversion. Patients with better visual acuity at time of initial diagnosis and history of panretinal photocoagulation (PRP) (p = 0.044) or focal laser (p = 0.035) in the primary eye were also more likely to convert. CONCLUSIONS Participants were most likely to develop fellow eye DMO within the first year after initial DMO diagnosis. In routine clinical practice, poor glycaemic control and DFD were risk factors associated with bilateral eye involvement. Clinicians may consider screening the fellow eye of high-risk individuals at each appointment within the first year of diagnosis.
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Affiliation(s)
- Peter Alsaloum
- Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Matthew W Russell
- Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Victoria Blaga
- Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Blanche L Kuo
- Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Anna K Wu
- Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Brian J Liu
- Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Carolina C S Valentim
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Colin M Xu
- Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Justin C Muste
- Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Madhukar Kumar
- Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Rishi P Singh
- Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH, 44106, USA.
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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Bheemidi AR, Kailar R, Valentim CCS, Kalur A, Singh RP, Talcott KE. Baseline factors and reason for cancellation of elective ophthalmic surgery. Eye (Lond) 2023; 37:2788-2794. [PMID: 36750587 PMCID: PMC10482885 DOI: 10.1038/s41433-023-02421-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 11/28/2022] [Accepted: 01/23/2023] [Indexed: 02/09/2023] Open
Abstract
OBJECTIVES To determine the baseline risk factors for elective ophthalmic surgery cancellations and characterise the reasons for cancellation. METHODS This is a retrospective, non-randomised study performed at a large tertiary ophthalmic centre. It included a consecutive sample of patients above the age of 18 who had an ophthalmic surgery scheduled at Cole Eye Institute, Cleveland Clinic, OH between January 2012 and December 2019. An automated search pull identified 75,908 scheduled surgeries (63,987 completed and 11,921 cancelled surgeries). Statistical analysis was performed using R (version 3.5.1). Main outcome measures were baseline factors that impact risk for surgery cancellation and reasons for surgery cancellation. RESULTS Analysis was performed on 69,963 scheduled surgeries (57.37% Female, 42.63% Male; Mean age of 62.72 years; 59,959 completed and 10,004 cancelled surgeries). Of the 2384 cancelled surgeries with reasons provided, the most common causes of cancellation were patient refusal (38.42%), patient health condition (18.79%), and rescheduling of surgery (15.27%). Female sex, black race, patient age less than 50 years, non-cataract surgeries, regional mean household income greater than $82,900, Medicare insurance, and geographical distance of less than 10 miles from home to the surgery site were each associated with a significantly increased risk of surgery cancellation (p < 0.01). CONCLUSIONS This study successfully identified several baseline factors predicting elective ophthalmic surgery cancellation. The clinical insights gained from these lines of enquiry may be used to construct models that not only identify patients at greater risk for cancellation but also highlight which interventions have greatest efficacy in preventing ophthalmic surgery cancellations.
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Affiliation(s)
| | - Roshni Kailar
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Carolina C S Valentim
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Aneesha Kalur
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rishi P Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Katherine E Talcott
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA.
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Liu BJ, Shaia JK, Allan K, Kuo BL, Singh RP, Talcott KE. The Incidence, Time to Development, and Risk Factors for Fellow Eye Retinal Vein Occlusions. Ophthalmic Surg Lasers Imaging Retina 2023; 54:471-476. [PMID: 37603786 DOI: 10.3928/23258160-20230726-03] [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: 08/23/2023]
Abstract
BACKGROUND AND OBJECTIVE Little is known about factors affecting risk or time to development of fellow eye retinal vein occlusion (RVO). The purpose of this study was to examine the incidence and risk factors for fellow eye RVO. PATIENTS AND METHODS This was a retrospective case-control study comparing unilateral and fellow eye RVO patients. This study was exempt by the Cleveland Clinic Institutional Review Board. RESULTS Out of 1,083 patients, fellow eye RVO had a cumulative incidence of 3.6% (95% CI 2.61, 4.94) with a median time to development of 18 months (95% CI 6.0, 28.0). Fellow eye disease was associated with multiple characteristics including chronic kidney disease (odds ratio [OR] 3.78, 95% CI 1.89 to 7.55) and diabetic retinopathy (3.18, 1.57 to 6.44). CONCLUSION While fellow eye RVO is relatively rare, it typically occurs within the first few years following initial diagnosis. Multiple characteristics were associated with fellow eye disease and time to onset. [Ophthalmic Surg Lasers Imaging Retina 2023;54:471-476.].
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Roan VD, Kuo BL, Liu BJ, Valentim CCS, Singh RP. Macular Thickness Fluctuations in Eyes With Diabetic Macular Edema Treated With Intravitreal Steroid. Ophthalmic Surg Lasers Imaging Retina 2023; 54:454-460. [PMID: 37535650 DOI: 10.3928/23258160-20230615-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Macular thickness fluctuations (MTF) over time may be more predictive of visual outcomes than absolute macular thickness in patients with diabetic macular edema (DME) treated with anti-vascular endothelial growth factor (anti-VEGF). It is unclear whether this association exists in DME patients treated with intravitreal steroids or whether steroids confer reduced MTF versus anti-VEGF treatments. PATIENTS AND METHODS MTF was compared before and after initiation of steroids in DME patients treated with intravitreal steroids. A mixed-effects linear regression model was used to determine the association between MTF and best-corrected visual acuity (BCVA). RESULTS Mean 12-month MTF significantly decreased after steroid initiation (61.1 μm versus 53.5 μm, P = 0.04, n = 105 eyes). Mean BCVA after 12 months was not significantly different from baseline. No significant association between post-steroid MTF and 12-month BCVA was found. CONCLUSION Steroid treatment decreases MTF while BCVA remains stable in DME patients previously treated with anti-VEGF. [Ophthalmic Surg Lasers Imaging Retina 2023;54:454-460.].
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Dhoot DS, Moini H, Reed K, Du W, Vitti R, Berliner AJ, Singh RP. Functional outcomes of sustained improvement on Diabetic Retinopathy Severity Scale with intravitreal aflibercept in the VISTA and VIVID trials. Eye (Lond) 2023; 37:2020-2025. [PMID: 35440699 PMCID: PMC10333274 DOI: 10.1038/s41433-022-02058-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 03/17/2022] [Accepted: 04/01/2022] [Indexed: 11/08/2022] Open
Abstract
AIMS To assess time to, cumulative incidence of, and functional benefit of achieving sustained ≥2-step Diabetic Retinopathy Severity Scale (DRSS) improvement in diabetic macular oedema (DMO). METHODS Post hoc analysis of VISTA/VIVID including eyes with DMO treated with intravitreal aflibercept injections (IAI), 2 mg q4 weeks (2q4, n = 250) or q8 weeks after 5 monthly doses (2q8, n = 249), or laser control (n = 249). Changes from baseline in best-corrected visual acuity (BCVA) and central subfield thickness (CST) were evaluated in sustained (≥2 consecutive visits) DRSS subgroups (≥1-step worsening, no change, ≥2-step improvement). RESULTS Time to sustained ≥2-step DRSS improvement was shorter for both the IAI 2q4 and IAI 2q8 groups versus laser (both log-rank p < 0.001). Cumulative incidences of sustained ≥2-step DRSS improvement with IAI 2q4 and IAI 2q8 versus laser were 40.0% and 42.8% versus 15.5% (both p < 0.001) through week 100. Mean differences (95% CI) in BCVA gains from baseline at weeks 52 and 100 between eyes with sustained ≥2-step DRSS improvement versus sustained ≥1-step DRSS worsening were -3.0 (-8.9, 2.9) and 6.2 (0.2, 12.2) letters with laser, and 4.2 (0.8, 7.6) and 4.9 (1.3, 8.4) letters with IAI combined, respectively. Difference (95% CI) in CST reduction was significantly greater only with IAI combined at week 100 (-83.0 [-140.8, -25.3]). Correlations between BCVA and CST changes were weak. CONCLUSIONS DMO eyes treated with IAI achieved sustained ≥2-step DRSS improvement significantly earlier and more frequently versus laser. This improvement was associated with greater BCVA gains, independent of CST reductions. TRIAL REGISTRATION ClinicalTrials.gov ( https://clinicaltrials.gov/ ) identifiers: NCT01363440 and NCT01331681 .
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Affiliation(s)
- Dilsher S Dhoot
- California Retina Consultants/Retina Consultants of America, Santa Barbara, CA, USA
| | - Hadi Moini
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | - Weiming Du
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - Robert Vitti
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | - Rishi P Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA.
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Muste JC, Russell MW, Iyer AI, Singh RP. Interventions to reduce loss to follow up in common retinal pathology: A systematic review. Eur J Ophthalmol 2023; 33:1513-1516. [PMID: 36537123 DOI: 10.1177/11206721221145058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
PURPOSE Loss to follow-up or fragmented follow-up episodes (LTFU) may contribute to suboptimal clinical outcomes, especially when comparing real world data to clinical trials. This systemic review gathers available evidence around interventions meant to decrease the LTFU in AMD, RVO, and DME patients. PATIENTS AND METHODS PubMed was queried using a literature search strategy and reviewed by the authors. Studies with interventions aimed at reducing lost to follow up were included. RESULTS Ten studies were extracted from 89 candidate publications. DISCUSSION Telephone interventions featuring assistance in scheduling in improving LTFU in urban, African American populations over 50 years old with diabetic retinopathy. The same interventions have shown promise in glaucoma, but remain understudied in AMD, RVO, and other geographic, ethnic, and socioeconomic demographics. CONCLUSION No sole intervention with efficacy in improving LTFU has been developed. A standardized definition of LTFU, as well as testing interventions across broad age, geography, ethnic, racial, and socioeconomic lines. Longitudinal data would also add credence to the efficacy of purported interventions. OTHER No sources of funding for this article.
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Affiliation(s)
- Justin C Muste
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Matthew W Russell
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Amogh I Iyer
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rishi P Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
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Singh RP, Welch L, Longo NL, Frese M. Impact of an immersive, interactive medical education initiative on guideline-based retinal disease management knowledge/competence and effectual practice change. BMC Ophthalmol 2023; 23:285. [PMID: 37349689 DOI: 10.1186/s12886-023-03034-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/10/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Retinal diseases, including wet or dry age-related macular degeneration, diabetic macular edema, and diabetic retinopathy (DR), are underdiagnosed and undertreated in the United States. Clinical trials support the effectiveness of anti-vascular endothelial growth factor (anti-VEGF) therapies for several retinal conditions, but real-world data suggest underuse by clinicians, resulting in patients experiencing poorer visual outcomes over time. Continuing education (CE) has demonstrated effectiveness at changing practice behaviors, but more research is needed to understand whether CE can help address diagnostic and treatment gaps. METHODS This test and control matched pair analysis examined pre-/post-test knowledge of retinal diseases and guideline-based screening and intervention among 10,786 healthcare practitioners (i.e., retina specialists, ophthalmologists, optometrists, primary care providers, diabetes educators, pharmacists/managed care specialists, and other healthcare providers, such as registered nurses, nurse practitioners, and physician assistants) who participated in a modular, interactive CE initiative. An additional medical claims analysis provided data on practice change, evaluating use of VEGF-A inhibitors among retina specialist and ophthalmologist learners (n = 7,827) pre-/post-education, compared to a matched control group of non-learners. Outcomes were pre-/post-test change in knowledge/competence and clinical change in application of anti-VEGF therapy, as identified by the medical claims analysis. RESULTS Learners significantly improved knowledge/competence scores on early identification and treatment, identifying patients who could benefit from anti-VEGF agents, using guideline-recommended care, recognizing the importance of screening and referral, and recognizing the importance of early detection and care for DR (all P-values = 0.003 to 0.004). Compared with matched controls, learners' incremental total injections for anti-VEGF agents for retinal conditions increased more after the CE intervention (P < 0.001); specifically, there were 18,513 more (new) anti-VEGF injections prescribed versus non-learners (P < 0.001). CONCLUSIONS This modular, interactive, immersive CE initiative resulted in significant knowledge/competence gains among retinal disease care providers and changes in practice-related treatment behaviors (i.e., appropriate consideration and greater incorporation of guideline-recommended anti-VEGF therapies) among participating ophthalmologists and retina specialists compared to matched controls. Future studies will utilize medical claims data to show longitudinal impact of this CE initiative on treatment behavior among specialists and impact on diagnosis and referral rates among optometrists and primary care providers who participate in future programming.
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Affiliation(s)
- Rishi P Singh
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
- Cleveland Clinic Martin Health, Stuart, FL, USA
| | - Lauren Welch
- Med Learning Group, 17th St #4, New York, NY, 10011, USA.
| | - Nicole L Longo
- Med Learning Group, 17th St #4, New York, NY, 10011, USA
| | - Matt Frese
- Med Learning Group, 17th St #4, New York, NY, 10011, USA
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Gupta U, Kumar M, Wu AK, Singh RP. Utilization of Crowdfunding for Medical Expenses Related to Vitrectomy. Ophthalmic Surg Lasers Imaging Retina 2023:1-3. [PMID: 37310746 DOI: 10.3928/23258160-20230508-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Kumar M, Singh RP. Pegcetacoplan in the treatment of geographic atrophy. Immunotherapy 2023. [PMID: 37259853 DOI: 10.2217/imt-2022-0263] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Geographic atrophy (GA) secondary to age-related macular degeneration is a leading cause of visual deterioration in the global elderly population, often causing a decreased quality of life. Perifoveal atrophy can significantly affect reading, low-light vision and driving. Similarly, foveal atrophy can cause defects in central visual acuity. While the complement cascade has been implicated as playing a pivotal role in disease pathogenesis, no approved treatment for GA currently exists. Two concurrent phase III trials, DERBY and OAKS, assessed pegcetacoplan (Apellis Pharmaceuticals, MA, USA), a selective complement component C3 inhibitor, with regard to reduction in GA progression. This article reviews the available clinical trial data relating to the efficacy and safety of pegcetacoplan in the treatment of GA secondary to age-related macular degeneration.
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Affiliation(s)
- Madhukar Kumar
- Case Western Reserve University School of Medicine, 10900 Euclid Avenue Cleveland, OH 44106, USA
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Rishi P Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Mehta N, Patil S, Modi V, Vardi R, Liu K, Singh RP, Sarraf D, Oden NL, VanVeldhuisen PC, Scott IU, Ip MS, Blodi BA, Modi Y. High Variation in Inner Retinal Reflectivity Predicts Poor Visual Outcome in Patients With Central Retinal Vein Occlusion: SCORE2 Report 21. Transl Vis Sci Technol 2023; 12:21. [PMID: 37367722 DOI: 10.1167/tvst.12.6.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
Purpose To assess the association of a novel spectral domain optical coherence tomography biomarker with 6-month visual acuity in in the Study of COmparative Treatments for REtinal Vein Occlusion 2. Methods Spectral domain optical coherence tomography volume scans were evaluated for inner retinal hyperreflectivity, quantified by optical intensity ratio (OIR) and OIR variation. Baseline visual acuity letter score (VALS), baseline OCT biomarkers, and month 1 OIR were correlated with VALS at month 6. Regression trees, a machine learning technique yielding readily interpretable models, were used to assess for variable interaction. Results Only baseline VALS correlated positively with month 6 VALS in multivariate regression. Regression trees detected a novel functional and anatomical interaction in a subgroup. Among patients with a baseline VALS worse than 43, those with an OIR variation at month 1 of more than 0.09 had a mean of 13 fewer letters of vision at 6 months compared with patients with an OIR variation of 0.09 or less. Conclusions Baseline VALS was the strongest predictor of month 6 VALS. Regression tree analysis detected an interaction effect, in which higher OIR variation at month 1 predicted worse 6-month VALS in patients with low VALS at baseline. OIR variation may serve as a predictor for poor visual outcome despite treatment of macular edema secondary to retinal vein occlusion in patients with poor vision at baseline. Translational Relevance Pixel heterogeneity in three-dimensional OCT data may serve as measure of disruption of the retinal laminations, and this factor may carry visually prognostic value.
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Affiliation(s)
- Nitish Mehta
- Department of Ophthalmology, NYU Langone Health, New York University, New York, NY, USA
| | - Sachi Patil
- Department of Ophthalmology, NYU Langone Health, New York University, New York, NY, USA
| | - Vikram Modi
- Department of Ophthalmology, NYU Langone Health, New York University, New York, NY, USA
| | - Rachel Vardi
- Department of Ophthalmology, NYU Langone Health, New York University, New York, NY, USA
| | - Kevin Liu
- Department of Ophthalmology, NYU Langone Health, New York University, New York, NY, USA
| | - Rishi P Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, The Cleveland Clinic, Cleveland, OH, USA
| | - David Sarraf
- Department of Ophthalmology, University of California - Los Angeles, Los Angeles, CA, USA
- Jules Stein Eye Institute, Los Angeles, CA, USA
| | | | | | - Ingrid U Scott
- Departments of Ophthalmology and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Michael S Ip
- Doheny Eye Institute, University of California, Los Angeles, CA, USA
| | - Barbara A Blodi
- University of Wisconsin Fundus Photograph Reading Center, Madison, WI, USA
| | - Yasha Modi
- Department of Ophthalmology, NYU Langone Health, New York University, New York, NY, USA
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Pandey A, Bhushan R, Rohilla A, Chakraborty S, Singh RP, Ojha S, Mehta D, Kumar S, Chamoli SK. Fabrication of thin Molybdenum backed target using rolling method. Appl Radiat Isot 2023; 199:110860. [PMID: 37290268 DOI: 10.1016/j.apradiso.2023.110860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 02/15/2023] [Accepted: 04/08/2023] [Indexed: 06/10/2023]
Abstract
A successful attempt was made to fabricate a thin foil of natural Mo target on a thick Au backing with Indium in between to improve adhesion between the foils. Rolling at elevated temperature was considered to fabricate Mo foil while gold foil was fabricated employing conventional rolling technique. The heating of Mo foil under natural environment lead to the oxidation or carbonization on foil surface which was confirmed through Energy Dispersive X-ray Spectroscopy (EDS) measurements. Indium of thickness ∼86μg/cm2 was evaporated on Mo foil to improve adhesion between Mo and Au foils. The characterization of fabricated thin Mo foil was done using the Energy Dispersive X-ray Spectroscopy (EDS) and the Scanning Electron microscope (SEM) techniques. Thickness measurement of the target (Mo-Au) was done using Energy Dispersive X-ray Fluorescence (EDXRF) technique, in the measurements the thickness of the Mo foil and of gold backing are found out to be 1.3 mg/cm2 and 9 mg/cm2 respectively.
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Affiliation(s)
- Anand Pandey
- Department of Physics & Astrophysics, University of Delhi, New Delhi, India
| | - Ravi Bhushan
- Department of Physics & Astrophysics, University of Delhi, New Delhi, India
| | - Aman Rohilla
- Institute of Space Sciences, Shandong University, Weihai 264209, People's Republic of China
| | - S Chakraborty
- Variable Energy Cyclotron Centre, Kolkata 700064, India
| | - R P Singh
- Inter University Accelerator Centre, Aruna Asaf Ali Marg, New Delhi, India
| | - Sunil Ojha
- Inter University Accelerator Centre, Aruna Asaf Ali Marg, New Delhi, India
| | - D Mehta
- Department of Physics, Punjab University, Chandigarh, India
| | - Sanjeev Kumar
- Goswami Ganesh Dutta Sanatan Dharma College, Sector 32 Chandigarh, India
| | - S K Chamoli
- Department of Physics & Astrophysics, University of Delhi, New Delhi, India.
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Dorney I, Shaia J, Kaelber DC, Talcott KE, Singh RP. Risk of New Retinal Vascular Occlusion After mRNA COVID-19 Vaccination Within Aggregated Electronic Health Record Data. JAMA Ophthalmol 2023; 141:441-447. [PMID: 37052897 PMCID: PMC10102921 DOI: 10.1001/jamaophthalmol.2023.0610] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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: 11/01/2022] [Accepted: 01/31/2023] [Indexed: 04/14/2023]
Abstract
Importance New-onset retinal vascular occlusion (RVO) occurring acutely after messenger RNA (mRNA) COVID-19 vaccination has been described in recent literature. Because RVO can cause vision loss or blindness, an epidemiologic investigation evaluating this potential association is of great importance to public health. Objective To investigate how often patients are diagnosed with new RVO acutely after the mRNA COVID-19 vaccine compared with influenza and tetanus, diphtheria, pertussis (Tdap) vaccines. Design, Setting, and Participants A retrospective population-based cohort design using the TriNetX Analytics platform, a federated, aggregated electronic health record (EHR) research network containing the deidentified EHR data of more than 103 million patients, was used to examine aggregate EHR data. Data were collected and analyzed on October 20, 2022. Data on patients within the TriNetX Analytics platform were searched for the presence of vaccination Common Procedural Technology codes, and instances of newly diagnosed RVO within 21 days of vaccination were recorded and reported. Propensity score matching based on demographic characteristics (age, sex, race and ethnicity) and comorbidities (diabetes, hypertension, and hyperlipidemia) was performed between vaccination groups for evaluation of relative risks (RRs). Main Outcomes and Measures The appearance of a new-encounter diagnosis of RVO within 21 days of the mRNA COVID-19 vaccination was the primary outcome. Historical comparison cohorts of patients receiving influenza and Tdap vaccinations allowed for evaluation of the RRs for RVO. Results Of 3 108 829 patients (mean [SD] age at vaccination, 50.7 [20.4] years; 56.4% women) who received the mRNA COVID-19 vaccine, 104 (0.003%; 95% CI, 0.003%-0.004%) patients had a new diagnosis of RVO within 21 days of vaccination. After propensity score matching, the RR for new RVO diagnosis after the first dose of COVID-19 vaccination was not significantly different from that after influenza (RR, 0.74; 95% CI, 0.54-1.01) or Tdap (RR, 0.78; 95% CI, 0.44-1.38) vaccinations, but was greater when compared with the second dose of the COVID-19 vaccination (RR, 2.25; 95% CI, 1.33-3.81). Conclusions and Relevance The findings of this study suggest that RVO diagnosed acutely after mRNA COVID-19 vaccination occurs extremely rarely at rates similar to those of 2 different historically used vaccinations, the influenza and Tdap vaccines. No evidence suggesting an association between the mRNA COVID-19 vaccination and newly diagnosed RVO was found.
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Affiliation(s)
- Ian Dorney
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jacqueline Shaia
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - David C. Kaelber
- Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
- The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio
| | - Katherine E. Talcott
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rishi P. Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
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Kailar RS, Perkins SW, Kuo BL, Singh RP. Characterizing and Predicting Limited Early Response in Eyes With Retinal Vein Occlusion Using Machine Learning in Routine Clinical Practice. Ophthalmic Surg Lasers Imaging Retina 2023; 54:231-237. [PMID: 37043409 DOI: 10.3928/23258160-20230317-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
OBJECTIVE To characterize and predict limited early responders (LER) in eyes with retinal vein occlusion (RVO) treated with anti-vascular endothelial growth factor (anti-VEGF). PATIENTS AND METHODS This retrospective cohort study of 116 eyes with edema secondary to RVO characterized early responders (ER) and LER 3 months after initiating anti-VEGF treatment. Baseline characteristics and 12-month outcomes were compared. A machine learning (ML) algorithm was developed to predict LER. RESULTS At baseline, LER had higher best-corrected visual acuity (BCVA) than ER (P< 0.0001) and lower central subfield thickness (CST) than ER (P< 0.01). At 12 months, change in BCVA was + 0.8 and + 21.4 letters, and change in CST was -104.4 and -187.1 μm for LER and ER, respectively (P < 0.0001, P < 0.05). The ML algorithm achieved area under the receiver operating characteristic curve = 0.73. CONCLUSION ER eyes experienced greater functional and anatomical improvements at 12 months in routine clinical practice than LER. The ML algorithm achieved moderately high performance predicting LER. [Ophthalmic Surg Lasers Imaging Retina 2023;54:231-237.].
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