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Weinstein O, Kridin M, Kridin K, Mann O, Cohen AD, Zloto O. The risk of retinal vein occlusion among patients with neovascular age related macular degeneration: a large-scale cohort study. Eye (Lond) 2023; 37:1445-1450. [PMID: 35778605 PMCID: PMC10170074 DOI: 10.1038/s41433-022-02163-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To examine the risk for retinal-vein-occlusion (RVO) in patients with neovascular age-related-macular-degeneration (AMD) as compared to age- and sex-matched controls. METHOD This is a population-based, cohort study. The study encompassed 24,578 consecutive patients with neovascular AMD and 66,129 control subjects. Multivariate cox regression analysis was utilized to detect the risk of RVO among patients with neovascular AMD. Predictors of RVO in patients with neovascular AMD were identified using multivariate logistic regression analysis. Mortality of patients was assessed using Kaplan-Meier method. RESULTS The incidence rate of RVO was estimated at 1.25 (95% CI, 1.06-1.45) per 1000 person-years among patients with neovascular AMD and 0.25 (95% CI, 0.20-0.31) per 1000 person-years among controls. Patients with neovascular AMD were associated with an increased risk of RVO (adjusted HR, 4.35; 95% CI, 3.34-5.66; P < 0.001). Among patients with neovascular AMD, older age (≥79.0 years) was associated with a decreased risk of RVO (adjusted OR, 0.50; 95% CI, 0.37-0.70; P < 0.001), whilst a history of glaucoma increased the likelihood of RVO (adjusted OR, 2.66; 95% CI, 1.94-3.65; P < 0.001). Patients with neovascular AMD and comorbid RVO had a comparable risk of all-cause mortality relative to other patients with neovascular AMD (HR, 0.90; 95% CI, 0.67-1.22; P = 0.500) CONCLUSIONS: An increased risk of RVO was found among patients with neovascular AMD. Younger age and glaucoma predicted the development of RVO in patients with neovascular AMD. Awareness of this comorbidity is of benefit for clinicians as patients with neovascular AMD might be carefully examined for RVO signs and complications.
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Affiliation(s)
- Orly Weinstein
- Clalit Health Services, Tel-Aviv, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Ben-Gurion Ave, Beer Sheva, Israel
| | - Mouhammad Kridin
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Khalaf Kridin
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Oran Mann
- Clalit Health Services, Tel-Aviv, Israel
| | - Arnon D Cohen
- Clalit Health Services, Tel-Aviv, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Ben-Gurion Ave, Beer Sheva, Israel
| | - Ofira Zloto
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel.
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Romano F, Lamanna F, Gabrielle PH, Teo KYC, Battaglia Parodi M, Iacono P, Fraser-Bell S, Cornish EE, Nassisi M, Viola F, Agarwal A, Samanta A, Chhablani J, Staurenghi G, Invernizzi A. Update on Retinal Vein Occlusion. Asia Pac J Ophthalmol (Phila) 2023; 12:196-210. [PMID: 36912792 DOI: 10.1097/apo.0000000000000598] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/11/2022] [Indexed: 03/14/2023] Open
Abstract
Retinal vein occlusion represents the second leading cause of retinal vascular disorders, with a uniform sex distribution worldwide. A thorough evaluation of cardiovascular risk factors is required to correct possible comorbidities. The diagnosis and management of retinal vein occlusion have changed tremendously in the last 30 years, but the assessment of retinal ischemia at baseline and during follow-up examinations remains crucial. New imaging techniques have shed light on the pathophysiology of the disease and laser treatment, once the only therapeutic option, is now only one of the possible approaches with antivascular endothelial growth factors and steroid injections being preferred in most cases. Nowadays long-term outcomes are better than those achievable 20 years ago and yet, many new therapeutic options are under development, including new intravitreal drugs and gene therapy. Despite this, some cases still develop sight-threatening complications deserving a more aggressive (sometimes surgical) approach. The purpose of this comprehensive review is to reappraise some old but still valid concepts and to integrate them with new research and clinical data. The work will provide an overview of the disease's pathophysiology, natural history, and clinical features along with a detailed discussion on the advantages of multimodal imaging and of the different treatment strategies with the aim of providing retina specialists with the most updated knowledge in the field.
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Affiliation(s)
- Francesco Romano
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Francesca Lamanna
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | | | - Kelvin Y C Teo
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Maurizio Battaglia Parodi
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pierluigi Iacono
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Samantha Fraser-Bell
- Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Elisa E Cornish
- Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Marco Nassisi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Ophthalmological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Viola
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Ophthalmological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Aniruddha Agarwal
- Eye Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, US
- Department of Ophthalmology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Anindya Samanta
- Department of Ophthalmology and Visual Sciences, Texas Tech University Health Sciences Center, Lubbock, TX, US
| | - Jay Chhablani
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
- Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
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3
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Retinal Artery Occlusion as an Early Indicator of Macrovascular Complications in Diabetes. Am J Med 2023; 136:179-185. [PMID: 36170938 DOI: 10.1016/j.amjmed.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND A characteristic of the retinal circulation is that arterial occlusion is embolic or secondary to vasculitis but rarely or never due to in situ atherosclerosis. Therefore, retinal artery occlusion suggests the presence of cardiac or large-vessel disease outside the eye. This cohort study examined the general risk of macrovascular disease in individuals with diabetes, with or without retinal artery occlusion. METHODS We retrieved data on 992 subjects with incident retinal artery occlusion and preexisting diabetes, registered in Denmark between January 1, 2000, and December 31, 2018. Each retinal artery occlusion subject was matched for age, sex, and diabetes duration, with 5 control subjects with diabetes but without retinal artery occlusion. We performed survival analyses to compare the risk of extraocular macrovascular disease between the 2 groups in a 5-year follow-up. RESULTS After 1 year, the incidence of macrovascular disease in subjects with retinal artery occlusion was approximately 21 per 100 person-years (95% confidence interval [CI]: 18.11-24.29), compared to 6.25 per 100 patient-years (95% CI: 5.57-7.00) in those without retinal artery occlusion. After 5 years, the cumulative incidences of macrovascular disease were 51.2% (95% CI: 47.9-54.7%) and 29.4% (95% CI: 28.0-30.8%) in patients with diabetes with or without retinal artery occlusion, respectively. Hazard rate ratios were 3.36 (95% CI: 2.79-4.05) after 1 year and 2.27 (95% CI: 2.04-2.53) after 5 years. CONCLUSION Among individuals with diabetes, those diagnosed with retinal artery occlusion had a higher general risk of macrovascular complications for at least 5 years after the occlusion event compared with those without retinal artery occlusion.
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Ørskov M, Vorum H, Larsen TB, Lip GYH, Bek T, Skjøth F. Similarities and differences in systemic risk factors for retinal artery occlusion and retinal vein occlusion: A nationwide case-control study. Int Ophthalmol 2022; 43:817-824. [PMID: 36056288 DOI: 10.1007/s10792-022-02483-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/20/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND To investigate the relationship between risk factors for retinal artery occlusion (RAO) and retinal vein occlusion (RVO) and thereby identify similarities and differences between the two types of retinal vascular occlusions. METHODS In this case-control study, 5708 patients with RAO were included and matched with three patients with RVO each. The patients with RVO were matched on sex and age at index date. All patients, personal information, diagnoses, and prescriptions were obtained from the Danish nationwide registries. Adjusted conditional logistic regression was used to investigate the association of RAO and RVO with the included risk factors. RESULTS RAO was stronger associated with arterial hypertension, heart failure, ischemic heart disease, peripheral artery disease, and stroke than RVO, with effect measures ranging from 1.10 to 2.21. RVO was associated with cataract and glaucoma with effect measures of 0.80 (95% CI 0.73-0.87) and 0.65 (95% CI 0.56-0.76), respectively. CONCLUSION Differences in the level of associations with the included risk factors suggests differences in the pathophysiologies of the two diseases. The main pathophysiology associated with RAO was atherosclerosis, whereas the main pathophysiology associated with RVO was changes in the pressure gradients of the eyes.
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Affiliation(s)
- Marie Ørskov
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark. .,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark.
| | - Henrik Vorum
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark
| | - Torben Bjerregaard Larsen
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus N, Denmark
| | - Flemming Skjøth
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark.,Unit for Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
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Ørskov M, Vorum H, Bjerregaard Larsen T, Vestergaard N, Lip GYH, Bek T, Skjøth F. A review of risk factors for retinal vein occlusions. Expert Rev Cardiovasc Ther 2022; 20:761-772. [PMID: 35972726 DOI: 10.1080/14779072.2022.2112667] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Risk factors for retinal vein occlusion have been extensively studied, with varying population sizes. Smaller populations result in less certain measures of associations. The present review included studies with a relevant population size to identify clinically relevant risk factors for retinal vein occlusion. Understanding the risk factors of retinal vein occlusion is important for the management of these patients. AREAS COVERED A comprehensive literature review was conducted through a systematic literature search in PubMed and Embase. Additional studies were selected from cross references in the assessed studies. Weighted effect measures were calculated for all included risk factors.Risk factors associated with retinal vein occlusion included cardiovascular diseases, eye diseases, systemic diseases, medical interventions, and sociodemographic factors. EXPERT OPINION This review provided an extensive overview of a wide variety of risk factors increasing the risk of developing retinal vein occlusion. The severity of the identified risk factors indicated that these patients have been in contact with the health care system before their retinal vein occlusion event. Therefore, the clinical course for patients with retinal vein occlusion may benefit from a multidisciplinary collaboration between ophthalmologists and especially cardiologists.
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Affiliation(s)
- Marie Ørskov
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Henrik Vorum
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark
| | - Torben Bjerregaard Larsen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Nanna Vestergaard
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark
| | - Gregory Y H Lip
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus N, Denmark
| | - Flemming Skjøth
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark.,Unit for Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
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Rong X, Tian H, Yang L, Li W. Function-first ligandomics for ocular vascular research and drug target discovery. Exp Eye Res 2019; 182:57-64. [PMID: 30904565 DOI: 10.1016/j.exer.2019.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/21/2019] [Accepted: 03/15/2019] [Indexed: 12/29/2022]
Abstract
Human eyes may develop different vascular diseases with neovascularization and/or leakage, including wet age-related macular degeneration (AMD), diabetic macular edema (DME), proliferative diabetic retinopathy (PDR), retinopathy of prematurity, corneal neovascularization and intraocular tumors. A breakthrough in therapy is the advent and approval of vascular endothelial growth factor (VEGF) inhibitors. However, anti-VEGF drugs not only have limited efficacy to treat AMD, DME and PDR but also are not approved for other ocular indications. The key to addressing these unmet clinical needs is to develop novel therapies against VEGF-independent angiogenic factors or signaling pathways for alternative or combination therapy. We recently developed the first paradigm of ligandomics for global mapping of cell-wide ligands as well as disease-selective ligands. Therapies targeting disease-selective angiogenic or vascular leakage factors likely have high efficacy, minimal side effects, wide therapeutic windows and relatively low drug attrition rates. A critical challenge is how to distinguish between genuine drug targets and spurious hits identified by high-throughput ligandomics. Here we exploited the unique advantages of the eye and extracellular ligands by combining ligandomics with "function-first" and/or "therapy-first" analyses to efficiently characterize functional activity, disease selectivity, pathogenic role and therapeutic potential of identified ligands. The innovative function- or therapy-first ligandomics will systematically and reliably delineate disease-selective angiogenic or vascular leakage factors and markedly facilitate ocular vascular research and ligand-guided targeted anti-angiogenic therapy.
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Affiliation(s)
- Xin Rong
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Ophthalmology, Peking University First Hospital, Beijing, China
| | | | - Liu Yang
- Department of Ophthalmology, Peking University First Hospital, Beijing, China
| | - Wei Li
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, USA.
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7
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Risk of retinal artery occlusion in patients with diabetes mellitus: A retrospective large-scale cohort study. PLoS One 2018; 13:e0201627. [PMID: 30091989 PMCID: PMC6084946 DOI: 10.1371/journal.pone.0201627] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 06/21/2018] [Indexed: 12/14/2022] Open
Abstract
There is a globally increasing prevalence and incidence of diabetes mellitus (DM). Prolonged hyperglycaemia could lead to both macrovascular damage, such as carotid artery atherosclerosis, and microvascular damage, such as retinal arteriolar narrowing, and might contribute to retinal artery occlusion (RAO). Accordingly, it is important to determine whether DM is a contrubuting factor of RAO. We conducted a retrospective cohort study that included 241,196 DM patients from the Longitudinal Cohort of Diabetes Patients Database who were recruited between 2003 and 2005. An age- and sex-matched non-DM control group included the same number of patients who were selected from the Taiwan Longitudinal Health Insurance Database of 2000. Relevant data of each patient were collected from the index date until December 2013. The incidence and risk of RAO were calculated and compared between the DM and non-DM groups. The hazard ratio for RAO was calculated using Cox proportional hazards regression analysis after adjusting for confounders. The cumulative incidence rate of RAO was calculated by Kaplan-Meier analysis. In total, 317 patients with DM and 144 controls developed RAO during the follow-up period, leading to an incidence rate of RAO in DM patients that was 2.30 times (95% confidence interval [CI] = 1.89-2.80) greater than that in controls. After adjustment for potential confounders, patients with DM were 2.11 times (95% CI, 1.71-2.59) more likely to develop RAO in the total study cohort. In conclusion, DM increases the risk of RAO, which is an interdisciplinary emergency. Close collaboration between endocrinologists and ophthalmologists is important in managing RAO following DM.
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8
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Wirth MA, Becker MD, Graf N, Michels S. Aflibercept in branch retinal vein occlusion as second line therapy: clinical outcome 12 months after changing treatment from bevacizumab/ranibizumab-a pilot study. Int J Retina Vitreous 2016; 2:20. [PMID: 27847638 PMCID: PMC5088487 DOI: 10.1186/s40942-016-0045-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 08/14/2016] [Indexed: 12/22/2022] Open
Abstract
Purpose To evaluate the effect of aflibercept (as second line therapy) on the clinical outcome in patients with chronic macular edema secondary to branch retinal vein occlusion (BRVO) insufficiently responding to prior treatment with bevacizumab and/or ranibizumab. Methods Ten eyes of ten patients (n = 10) with chronic macular edema secondary to BRVO were included in a retrospective analysis. These patients received aflibercept after an insufficient response to treatment with ranibizumab and/- or bevacizumab. All intravitreal injections were administered according to a “treat and extend” regimen. Insufficient response was defined as the necessity of injection intervals of 6 weeks or less. The primary outcome of the study was the change in mean injection interval from baseline (prior switching to aflibercept) to month 12 after conversion to aflibercept. Secondary outcomes included the change in best corrected visual acuity (BCVA), central retinal thickness (CRT), central retinal volume (CRV) and intraocular pressure (IOP). Results All patients completed 12 months follow-up. In total, patients received a mean of 15.5 injections of ranibizumab and/or bevacizumab over a mean period of 23.1 months prior to switching to aflibercept. The primary endpoint indicated a significant increase in the injection interval from 5.0 weeks at baseline to 8.3 weeks at month 12 (p = 0.002). Secondary outcomes showed favorable results. Mean BCVA increased from 72.7 letters at baseline to 77.9 letters at month 12 after treatment initiation with aflibercept (+5.2 letters, p = 0.375). Correspondingly, CRT values decreased by 61.7 µm (p = 0.344) and the mean CRV (6 mm diameter) by 0.86 mm3 (p = 0.021) from baseline to 1 year after treatment initiation with aflibercept. During the treatment period with aflibercept no significant changes in intraocular pressure were registered (p = 0.238). Conclusions Changing treatment to aflibercept in patients with chronic macular edema secondary to BRVO showed a statistically significant extension of the retreatment interval as well as beneficial anatomic changes in our study group. Our data do not allow a definite conclusion since the study was not controlled.
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Affiliation(s)
- Magdalena A Wirth
- Department of Ophthalmology, City Hospital Triemli Zurich, Zurich, Switzerland
| | - Matthias D Becker
- Department of Ophthalmology, City Hospital Triemli Zurich, Zurich, Switzerland ; Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | | | - Stephan Michels
- Department of Ophthalmology, City Hospital Triemli Zurich, Zurich, Switzerland ; Department of Ophthalmology, University of Zurich, Zurich, Switzerland
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Venous thromboembolism does not share familial susceptibility with retinal vascular occlusion or glaucoma: a nationwide family study. J Thromb Thrombolysis 2016; 42:505-12. [DOI: 10.1007/s11239-016-1387-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tah V, Orlans HO, Hyer J, Casswell E, Din N, Sri Shanmuganathan V, Ramskold L, Pasu S. Anti-VEGF Therapy and the Retina: An Update. J Ophthalmol 2015; 2015:627674. [PMID: 26417453 PMCID: PMC4568374 DOI: 10.1155/2015/627674] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 06/28/2015] [Accepted: 07/05/2015] [Indexed: 01/31/2023] Open
Abstract
Ocular angiogenesis and macular oedema are major causes of sight loss across the world. Aberrant neovascularisation, which may arise secondary to numerous disease processes, can result in reduced vision as a result of oedema, haemorrhage, and scarring. The development of antivascular endothelial growth factor (anti-VEGF) agents has revolutionised the treatment of retinal vasogenic conditions. These drugs are now commonly employed for the treatment of a plethora of ocular pathologies including choroidal neovascularisation, diabetic macular oedema, and retinal vein occlusion to name a few. In this paper, we will explore the current use of anti-VEGF in a variety of retinal diseases and the impact that these medications have had on visual outcome for patients.
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Affiliation(s)
- Vikas Tah
- The Royal Berkshire NHS Foundation Trust, Craven Road, Reading RG1 5AN, UK
| | - Harry O. Orlans
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
| | - Jonathan Hyer
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
| | - Edward Casswell
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
| | - Nizar Din
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
| | | | - Louise Ramskold
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
| | - Saruban Pasu
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
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Budzinskaya MV, Mazurina NK, Egorov AE, Kuroedov AV, Loskutov IA, Plyukhova AA, Razik S, Ryabtseva AA, Simonova SV. [Retinal vein occlusion management algorithm. Part 1. Classification, diagnosis, and acute-stage treatment]. Vestn Oftalmol 2015; 131:51-56. [PMID: 26977727 DOI: 10.17116/oftalma2015131651-56] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Considering an upward global trend in cardiovascular disease rates, retinal vein occlusion (RVO) in particular, development of therapeutic guidelines is a pressing issue in ophthalmology. Risk factors for RVO include hypertension, atherosclerosis, diabetes mellitus, blood disorders, inflammatory disorders, and prescription drug use. Three stages of RVO have been identified. By location, the entity can be divided into three big groups: central retinal vein occlusion (CRVO), branch retinal vein occlusion (BRVO), and hemicentral retinal vein occlusion (HCRVO), each being either ischemic or nonischemic. Functional prognosis is better in nonischemic occlusions. Patient management comprises acute-stage treatment (anticoagulants, fibrinolytic agents, and hemodilution) and struggling with ocular complications (intravitreal injections and laser coagulation). It is essential that primary assessment and follow-up of patients at any stage of RVO include optical coherence tomography and fluorescent angiography.
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Affiliation(s)
- M V Budzinskaya
- Research Institute of Eye Diseases, 11 A, B, Rossolimo St., Moscow, Russian Federation, 119021
| | - N K Mazurina
- Posterior segment eye surgery and diagnostics center LLC, 2-aya Vladimirskaya St., Moscow, Russian Federation, 111123
| | - A E Egorov
- Pirogov Russian National Research Medical University, 1 Ostrovityanova St., Moscow, Russian Federation 117997
| | - A V Kuroedov
- Pirogov Russian National Research Medical University, 1 Ostrovityanova St., Moscow, Russian Federation 117997; Mandryka Clinical Research and Training Medical Center, 8A Bol'shaya Olen'ya St., Moscow, Russian Federation, 107014
| | - I A Loskutov
- Scientific Clinical Center of JSC Russian Railways, 20 Chasovaya St., Russian Federation, 125315
| | - A A Plyukhova
- 'SovMedTeh' LLC, Eximer clinic, 3-1 Marksistskaya St., Moscow, Russian Federation, 109147
| | - S Razik
- Medical diagnostic center 'Olimp' LLC, 77 Udal'tsova St., Moscow, Russian Federation, 119454
| | - A A Ryabtseva
- Moscow Regional Research and Clinical Institute named after M.F. Vladimirskiy, 61/2 Shchepkina St., Moscow, Russian Federation, 129110
| | - S V Simonova
- S.P. Botkin State Clinical Hospital, Branch #1, Moscow Department of Public Health, 7 Mamonovskiy pereulok, Moscow, Russian Federation, 123001
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Keren S, Loewenstein A, Coscas G. Pathogenesis, prevention, diagnosis and management of retinal vein occlusion. World J Ophthalmol 2014; 4:92-112. [DOI: 10.5318/wjo.v4.i4.92] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 08/26/2014] [Accepted: 09/17/2014] [Indexed: 02/06/2023] Open
Abstract
Retinal vein occlusion (RVO) is the second vascular retinal cause of visual loss and defined by the occlusion of a retinal vein. It is divided into branch retinal vein occlusion or central retinal vein occlusion, depending on the location of occlusion. RVO has severe medical, financial and social implications on the patients. The diagnosis of the disease is easier nowadays with the use of spectral domain optical coherence tomography and fluorescein angiography. The treatment options for RVO have changed dramatically over the past few years with the introduction of the intravitreal injections of dexamethasone (Ozurdex), bevacizumab (Avastin), ranibizumab (Lucentis) and aflibercept (EYLEA), along with the panretinal laser photocoagulation, abandoning former treatment modalities and surgical solution. This manuscript is a review of current literature about RVO with emphasize on the pathophysiology, risk factors and prevention, diagnosis and sub-group categorization and treatments including medical and surgical. Since no official guidelines are available for the treatment of RVO patients, and considering the latest developments in the treatment options, and the variety of follow-up and treatment modalities, this manuscript aims to provide tools and knowledge to guide the physician in treating RVO patients, based on the latest publications from the literature and on several of the patients characteristics.
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DIFFERENTIAL DIAGNOSIS OF MACULAR EDEMA OF DIFFERENT PATHOPHYSIOLOGIC ORIGINS BY SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY. Retina 2014; 34:2218-32. [DOI: 10.1097/iae.0000000000000228] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sarao V, Bertoli F, Veritti D, Lanzetta P. Pharmacotherapy for treatment of retinal vein occlusion. Expert Opin Pharmacother 2014; 15:2373-84. [DOI: 10.1517/14656566.2014.956083] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Valentina Sarao
- University of Udine, Department of Ophthalmology, Piazza Santa Maria della Misericordia, 33100 Udine, Italy ;
| | - Federica Bertoli
- University of Udine, Department of Ophthalmology, Piazza Santa Maria della Misericordia, 33100 Udine, Italy ;
| | - Daniele Veritti
- University of Udine, Department of Ophthalmology, Piazza Santa Maria della Misericordia, 33100 Udine, Italy ;
- Istituto Europeo di Microchirugia Oculare (IEMO), Udine, Italy
| | - Paolo Lanzetta
- University of Udine, Department of Ophthalmology, Piazza Santa Maria della Misericordia, 33100 Udine, Italy ;
- Istituto Europeo di Microchirugia Oculare (IEMO), Udine, Italy
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Chang YS, Chu CC, Weng SF, Chang C, Wang JJ, Jan RL. The risk of acute coronary syndrome after retinal artery occlusion: a population-based cohort study. Br J Ophthalmol 2014; 99:227-31. [PMID: 25147366 DOI: 10.1136/bjophthalmol-2014-305451] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To investigate the risk of acute coronary syndrome (ACS) following retinal artery occlusion (RAO). METHODS The study cohort included all patients diagnosed with RAO between January 1999 and December 2008 (n=688) in the Taiwan Longitudinal Health Insurance Database 2000. The control group included randomly selected patients (n=4128) from the same database that were matched to the study group, using a propensity score, for age, gender, and comorbid diabetes mellitus, hypertension, hyperlipidaemia, chronic renal disease and atrial fibrillation status. The ACS-free survival rate was calculated using Kaplan-Meier analysis. Cox proportional hazard regression analysis was used to obtain the adjusted HR for ACS after adjustment for potential confounding factors. The incidence and risk of ACS were compared between the RAO and control groups. RESULTS Thirty-seven patients in the RAO group (5.38%) and 138 controls (3.34%) had ACS (p=0.0063) during the follow-up period, resulting in a significantly higher risk of ACS in the RAO group (HR=1.67, 95% CI 1.16 to 2.40). After adjustment for potential confounders, the HR for developing ACS in the RAO group was 1.72 (95% CI 1.20 to 2.47) times higher than that of controls. When stratified by RAO type, the adjusted HR for ACS was 3.57 (95% CI 2.09 to 6.10) for the central RAO subgroup. CONCLUSIONS We found that RAO increased the risk for ACS. We recommend thorough follow-up cardiovascular examinations and medical prevention for ACS in patients following RAO.
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Affiliation(s)
- Yuh-Shin Chang
- Department of Ophthalmology, Chi Mei Medical Center, Tainan, Taiwan
| | - Chin-Chen Chu
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan Departments of Recreation and Health-Care Management, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Shih-Feng Weng
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan Hospital and Health Care Administration, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Chun Chang
- Department of Education, University of Taipei, Taipei, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Ren-Long Jan
- Department of Pediatrics, Chi Mei Medical Center, Liouying, Tainan, Taiwan Graduate Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan
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La Spina C, De Benedetto U, Parodi MB, Coscas G, Bandello F. Practical management of retinal vein occlusions. Ophthalmol Ther 2012; 1:3. [PMID: 25135583 PMCID: PMC4108135 DOI: 10.1007/s40123-012-0003-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Indexed: 11/26/2022] Open
Abstract
Retinal vein occlusion (RVO) is the second most common cause of visual impairment due to retinal disease after diabetic retinopathy. Nowadays, the introduction of new, powerful diagnostic tools, such as spectral domain optical coherence tomography, and the widespread diffusion of intravitreal drugs, such as vascular endothelial grow factor inhibitors or implantable steroids, have dramatically changed the management and prognosis of RVO. The authors aim to summarize and review the main clinical, diagnostic, and therapeutic aspects of this condition. The authors conducted a review of the most relevant clinical trials and observational studies published within the last 30 years using a keyword search of MEDLINE, EMBASE, Current Contents, and Cochrane Library. Furthermore, for all treatments discussed, the level of evidence supporting its use, as per the US Preventive Task Force Ranking System, is provided.
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Affiliation(s)
- Carlo La Spina
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Via Olgettina, 60, 20132 Milan, Italy
| | - Umberto De Benedetto
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Via Olgettina, 60, 20132 Milan, Italy
| | - Maurizio Battaglia Parodi
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Via Olgettina, 60, 20132 Milan, Italy
| | - Gabriel Coscas
- Hôpital Intercommunal de Créteil, Service Universitaire d’ophtalmologie, Créteil, France
| | - Francesco Bandello
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Via Olgettina, 60, 20132 Milan, Italy
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Chang YS, Jan RL, Weng SF, Wang JJ, Chio CC, Wei FT, Chu CC. Retinal artery occlusion and the 3-year risk of stroke in Taiwan: a nationwide population-based study. Am J Ophthalmol 2012; 154:645-652.e1. [PMID: 22809785 DOI: 10.1016/j.ajo.2012.03.046] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 03/29/2012] [Accepted: 03/30/2012] [Indexed: 11/15/2022]
Abstract
PURPOSE To verify the association between retinal artery occlusion (RAO) and stroke with a large-scale nationwide study. DESIGN Retrospective nationwide population-based administrative database study. METHODS Data were collected from the Longitudinal Health Insurance Database 2000 (LHID2000), which contains claim data from 1 million randomly selected beneficiaries among Taiwan's 23 million residents. The study cohort consisted of all patients with a diagnosis of RAO from January 1999 through December 2006 (n = 464). The control group consisted of randomly selected patients (n = 2748) matched with the study group by age, sex, date of index medical care, and comorbid hypertension. Patients were tracked from their index date for 3 years. The Kaplan-Meier method was used to compute the stroke-free survival rate. Cox proportional hazard regressions were used to compute the adjusted stroke-free survival rate after adjusting for possible confounding factors. RESULTS Ninety-one RAO patients (19.61%) and 280 controls (10.05%) had a stroke (P < .0001) during the 3-year follow-up period. Compared with the controls, the incidence rate ratios of stroke in RAO patients were 9.46 at 0-1 month, 5.57 at 1-6 months, and 2.16 at 0-3 years after RAO (P < .0001). After adjusting for age, sex, and selected comorbid disorders, the hazard ratio of having a stroke for RAO patients was still 2.07 times higher than that of controls and 3.34 times higher in the ≤60-year-old subgroup. CONCLUSIONS RAO increases the risk for subsequent stroke. Early neurologic evaluation and secondary prevention for stroke are recommended for RAO patients.
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Affiliation(s)
- Yuh-Shin Chang
- Department of Ophthalmology, Chi Mei Medical Center, Tainan, Taiwan
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Coscas G, Loewenstein A, Augustin A, Bandello F, Battaglia Parodi M, Lanzetta P, Monés J, de Smet M, Soubrane G, Staurenghi G. Management of retinal vein occlusion--consensus document. ACTA ACUST UNITED AC 2011; 226:4-28. [PMID: 21577038 DOI: 10.1159/000327391] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Retinal vein occlusion (RVO) can have severe consequences for the people affected by the disease, including visual loss with costly social repercussions. Currently, there is no European consensus with regard to the management of RVO. Following a careful review of the medical literature as well as the data from several clinical trials, a collaborative group of retina specialists put forth practical recommendations based on the best available scientific evidence for the clinical approach to RVO. Taking into consideration the recent advances in diagnostic tools and management options, the present document aims to provide the European ophthalmologists with guidelines for clinical practice to the benefit of their patients.
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Affiliation(s)
- Gabriel Coscas
- Hôpital Intercommunal de Créteil, Service Universitaire d'Ophtalmologie, Créteil, France.
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Central retinal artery occlusion in Wegener's granulomatosis: a diagnostic dilemma. J Ophthalmic Inflamm Infect 2011; 1:71-5. [PMID: 21484179 PMCID: PMC3102859 DOI: 10.1007/s12348-010-0003-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2010] [Accepted: 09/07/2010] [Indexed: 11/03/2022] Open
Abstract
PURPOSE To report a case of central retinal artery occlusion (CRAO) in a patient with biopsy-verified Wegener's granulomatosis (WG) with positive C-ANCA. METHODS A 55-year-old woman presented with a 3-day history of acute painless bilateral loss of vision; she also complained of fever and weight loss. Examination showed a CRAO in the left eye and angiographically documented choroidal ischemia in both eyes. RESULTS The possibility of systemic vasculitis was not kept in mind until further studies were carried out; methylprednisolone pulse therapy was then started. Renal biopsy disclosed focal and segmental necrotizing vasculitis of the medium-sized arteries, supporting the diagnosis of WG, and cyclophosphamide pulse therapy was administered with gradual improvement, but there was no visual recovery. CONCLUSION CRAO as presenting manifestation of WG, in the context of retinal vasculitis, is very uncommon, but we should be aware of WG in the etiology of CRAO. This report shows the difficulty of diagnosing Wegener's granulomatosis; it requires a high index of suspicion, and we should obtain an accurate medical history and repeat serological and histopathological examinations. It emphasizes that inflammation of arteries leads to irreversible retinal infarction, and visual loss may occur.
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Abstract
Neuro-ophthalmology covers disorders that fall between the cracks of Neurology and Ophthalmology. Neurologists see patients with neuro-ophthalmic disorders. Recognition of the diagnosis is difficult enough, but treatment can be challenging. This article reviews several common neuro-ophthalmic disorders, outlining their features and treatments, from retinal vascular disorders to eye movements and blepharospasm.
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Affiliation(s)
- Byron Roderick Spencer
- Department of Ophthalmology, Moran Eye Center, University of Utah, 65 Mario Capecchi Drive, Salt Lake City, UT 84132, USA
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Gómez-Ulla F, Abraldes MJ, Basauri E, Fernández M, García-Layana A, Gili P, Montero J, Nadal J, Morales V, Saravia M, Cabrera F, Cervera E. [SERV clinical practice guidelines: management of retinal vein occlusion. Sociedad Española de Retina y Vitreo]. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2010; 85:294-309. [PMID: 21167436 DOI: 10.1016/j.oftal.2010.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 09/30/2010] [Indexed: 05/30/2023]
Abstract
PURPOSE A guidelines for the management of retinal vein occlusion is presented. This is necessary because at this moment several therapeutic alternatives have been developed although their role is not yet sufficiently defined. METHODS Review of the literature for evidence published up to date. Relevant literature was identified and the level of evidence graded. Evidence was then assessed for consistency, applicability and clinical impact. The information was contrasted with those guides published in other countries. RESULTS Taking into account the different options of treatment that are currently used, several modes of action are suggested. The role of the various complementary examinations are discussed and it is recommended that criteria for the treatment are based on clinical, angiographic, and tomographic findings. CONCLUSIONS Although there is no overall consensus, these guidelines promote a good standard of clinical practise and provide an update of the management of retinal vein occlusion.
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Affiliation(s)
- F Gómez-Ulla
- Complejo Hospitalario Universitario de Santiago de Compostela, Instituto Tecnológico de Oftalmología, Santiago de Compostela, España
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