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Recent Clinical Advances in Macular Degeneration and Retinal Diseases

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: closed (25 April 2023) | Viewed by 15997

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Dr. Takao Hirano

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Guest Editor

Department of Ophthalmology, School of Medicine, Shinshu University, Matsumoto 390-8621, Japan
Interests: diabetic retinopathy; diabetic macular edema; age-related macular degeneration; retinal vein occlusion; optical coherence tomography (OCT); OCT angiography; anti-vascular endothelial growth factor (VEGF) treatment; vitrectomy

Special Issue Information

Dear Colleagues,

Age-related macular degeneration (AMD) and retinal diseases warrant early diagnoses and prompt treatments to avoid vision loss or a significant reduction in patients’ quality of vision. Lately, technical advances in fundus imaging modalities, such as optical coherence tomography (OCT) and OCT angiography, have offered novel insights into retinal and choroidal diseases. Additionally, the treatment outcomes of vascular endothelial growth factor (VEGF)-related diseases, such as AMD, diabetic macular edema, and retinal vein occlusion, showed significant improvements following the advent of anti-VEGF therapy. Furthermore, technological innovations, such as minimally invasive vitrectomy significantly improved the prognosis of surgery performed for incurable diseases including retinal detachment and proliferative diabetic retinopathy. It is important to closely monitor progress in the evaluation and treatment protocol for macular degeneration and retinal diseases. This Special Issue of the Journal of Clinical Medicine focuses on recent clinical advances in macular degeneration and retinal diseases.

Dr. Takao Hirano
Guest Editor

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Keywords

age-related macular degeneration (AMD)
diabetic retinopathy
diabetic macular edema
retinal vein occlusion
optical coherence tomography (OCT)
OCT angiography
anti-vascular endothelial growth factor (VEGF) therapy
retinal laser photocoagulation
vitrectomy

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Published Papers (8 papers)

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Research

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15 pages, 939 KiB

Open AccessArticle

Serum Autoantibodies in Patients with Dry and Wet Age-Related Macular Degeneration

by Christina A. Korb, Sabine Beck, Dominik Wolters, Katrin Lorenz, Norbert Pfeiffer and Franz H. Grus

J. Clin. Med. 2023, 12(4), 1590; https://doi.org/10.3390/jcm12041590 - 17 Feb 2023

Cited by 4 | Viewed by 2191

Abstract

Background: To assess the serum autoantibody profile in patients with dry and exudative age-related macular degeneration compared with healthy volunteers to detect potential biomarkers, e.g., markers for progression of the disease. Materials and Methods: IgG Immunoreactivities were compared in patients suffering from dry age-related macular degeneration (AMD) (n = 20), patients with treatment-naive exudative AMD (n = 29) and healthy volunteers (n = 21). Serum was analysed by customized antigen microarrays containing 61 antigens. The statistical analysis was performed by univariate and multivariate analysis of variance, predictive data-mining methods and artificial neuronal networks were used to detect specific autoantibody patterns. Results: The immunoreactivities of dry and wet AMD patients were significantly different from each other and from controls. One of the most prominently changed reactivity was against alpha-synuclein (p ≤ 0.0034), which is known from other neurodegenerative diseases. Furthermore, reactivities against glyceraldehyde-3-phosphat-dehydrogenase (p ≤ 0.031) and Annexin V (p ≤ 0.034), which performs a major role in apoptotic processes, were significantly changed. Some immunoreacitvities were antithetic regulated in wet and dry-AMD, such as Vesicle transport-related protein (VTI-B). Conclusions: Comparison of autoantibody profiles in patients with dry and wet AMD revealed significantly altered immunoreactivities against proteins particularly found in immunological diseases, further neurodegenerative, apoptotic and autoimmune markers could be observed. A validation study has to explore if these antibody pattern can help to understand the underlying differences in pathogenesis, evaluate their prognostic value and if those could be possibly useful as additional therapeutic targets. Full article

(This article belongs to the Special Issue Recent Clinical Advances in Macular Degeneration and Retinal Diseases)

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12 pages, 10011 KiB

Open AccessArticle

Sex- and Age-Dependent Wide-Field Choroidal Thickness Differences in Healthy Eyes

by Naohisa Mihara, Shozo Sonoda, Hiroto Terasaki, Hideki Shiihara, Takato Sakono, Ryoh Funatsu and Taiji Sakamoto

J. Clin. Med. 2023, 12(4), 1505; https://doi.org/10.3390/jcm12041505 - 14 Feb 2023

Cited by 5 | Viewed by 1440

Abstract

In this study, we aimed to map and characterize the choroidal thickness over a wide area from the posterior pole to the vortex vein in normal eyes. This observational study included 146 healthy eyes (63 male). Three-dimensional volume data were acquired to create a choroidal thickness map using swept-source optical coherence tomography. The map was classified as type A if an area with a choroidal thickness >250 µm in the vertical direction from the optic disc, and the area corresponding to the watershed was not observed, or as type B if such an area was observed. The relationship between the ratio of groups A to B and age was compared by classifying the age for three age groups: <40, 40–60, and >60 years in men and women. In men and women, 69.8% and 49.4% were classified as type A, respectively, with significant sex differences (p = 0.013). The proportion of type B decreased with increasing age in both the sexes. There was a significant difference between ≤60 and >60 years in men and between ≤40 and >40 years in women (p < 0.05). To conclude, the wide-area choroidal thickness and the age-dependent changes in healthy eyes differed between the sexes. Full article

(This article belongs to the Special Issue Recent Clinical Advances in Macular Degeneration and Retinal Diseases)

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9 pages, 903 KiB

Open AccessArticle

Impact of the COVID-19 Pandemic on Anti-Vascular Endothelial Growth Factor Therapy for Diabetic Macular Edema in Japan

by Ryohei Komori, Yoshihiro Takamura, Yutaka Yamada, Masakazu Morioka, Hisashi Matsubara, Takao Hirano, Yoshinori Mitamura, Miho Shimizu, Sentaro Kusuhara, Tomoya Murakami, Ryotaro Nihei, Tetsuo Ueda, Hiroshi Kunikata, Tatsuya Jujo, Hiroto Terasaki, Daisuke Nagasato, Kousuke Noda, Rie Osaka, Kazuki Nagai, Shigeo Yoshida, Miho Nozaki, Hidetaka Noma, Gaku Ishigooka, Aya Takahashi, Osamu Sawada, Kazuhiro Kimura and Masaru Inatani Show full author list Hide full author list

J. Clin. Med. 2022, 11(22), 6794; https://doi.org/10.3390/jcm11226794 - 16 Nov 2022

Viewed by 1847

Abstract

Anti-vascular endothelial growth factor (VEGF) therapy for diabetic macular edema (DME) improves visual acuity. However, repeated injections during routine outpatient visits are required to maintain this effect. The recent sudden global outbreak of coronavirus disease 2019 (COVID-19) had a major impact on daily life, including medical care, such as the provision of VEGF therapy. We retrospectively investigated the relationship between the number of anti-VEGF injections for DME and the number of new COVID-19-positive patients at 23 centers in Japan. We also surveyed ophthalmologists regarding the impact of the COVID-19 pandemic on anti-VEGF therapy. In the third and fourth waves of the pandemic, when the number of infected patients increased, the number of injections significantly decreased. In the first, third, and fourth waves, the number of injections increased significantly during the last month of each wave. Approximately 60.9% of ophthalmologists reported that the number of injections decreased after the pandemic. Of the facilities, 52.2% extended the clinic visit intervals; however, there was no significant difference in the actual number of injections given between before and after the pandemic. Although the number of injections temporarily decreased, Japanese ophthalmologists maintained the total annual number of anti-VEGF injections for DME during the pandemic. Full article

(This article belongs to the Special Issue Recent Clinical Advances in Macular Degeneration and Retinal Diseases)

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11 pages, 3809 KiB

Open AccessArticle

Temporal Change in Anterior Chamber Depth after Combined Vitrectomy and Cataract Surgery Using Different Sizes of Intraocular Lens

by Yoshiaki Takahashi, Takao Hirano, Marie Nakamura, Yoshiaki Chiku, Ken Hoshiyama, Satoko Akahane, Keita Akahane and Toshinori Murata

J. Clin. Med. 2022, 11(21), 6430; https://doi.org/10.3390/jcm11216430 - 30 Oct 2022

Cited by 1 | Viewed by 1864

Abstract

This study aimed to investigate the temporal changes in the anterior chamber depth (ACD) and refractive prediction error (RPE) of 6 and 7 mm diameter intraocular lenses (IOLs) after cataract surgery or phacovitrectomy with or without sulfur hexafluoride (SF6) gas. We reviewed 120 eyes (120 patients) and divided them into six groups: three groups of cataract surgery alone and phacovitrectomy (with or without SF6), which were further divided according to IOL diameter (6 and 7 mm) used. We examined the ACD and IOL position using a swept-source anterior segment optical coherence tomograph at 1 day, 1 week, and 1 month postoperatively; and the RPE at 1 month postoperatively. The ACD and IOL position at postoperative day 1 in the SF6 injection groups were significantly smaller than those in the other groups (p < 0.01). At 1 week, the ACD and IOL position of the 6 mm IOL SF6 injection group was smaller than those in the other groups (p < 0.01); thus, complications such as synechia or pupillary capture should be considered in the early postopera-tive period of phacovitrectomy with SF6, especially in the 6 mm IOL. The ACD, IOL position, and RPE at 1 month did not significantly differ among the groups, regardless of the IOL diameter or SF6. In the SF6 injection groups, the ACD and IOL position gradually deepened with less gas. Full article

(This article belongs to the Special Issue Recent Clinical Advances in Macular Degeneration and Retinal Diseases)

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8 pages, 776 KiB

Open AccessArticle

Response to Initial Anti-Vascular Endothelial Growth Factor for Diabetic Macular Edema Is Significantly Correlated with Response to Third Consecutive Monthly Injection

by Satoshi Maeda, Masahiko Sugimoto, Yumiho Tenma, Hideyuki Tsukitome, Kumiko Kato, Shinichiro Chujo, Yoshitsugu Matsui, Hisashi Matsubara and Mineo Kondo

J. Clin. Med. 2022, 11(21), 6416; https://doi.org/10.3390/jcm11216416 - 29 Oct 2022

Cited by 2 | Viewed by 1359

Abstract

Purpose: To determine whether the response to the initial anti-vascular endothelial growth factor (anti-VEGF) injection to treat diabetic macular edema (DME) is significantly correlated with the response to the third consecutive monthly injection of the same anti-VEGF agent. Methods: Seventy eyes with DME that were treated with an anti-VEGF agent (16 eyes with 1.25-mg bevacizumab, 35 eyes with 0.5-mg ranibizumab, and 19 eyes with 2.0-mg aflibercept) were studied. They were treated with three consecutive monthly injections of one of the three anti-VEGF agents. The best-corrected visual acuity (BCVA) in the logarithm of the minimum angle of resolution (logMAR units) and the central macular thickness (CMT) were measured at the baseline, 1 week after the initial injection, and 1 month after the third consecutive monthly injection. The changes of both values from the baseline 1 week after the initial injection (day 7) and 1 month after the third monthly injection were determined. The significance of the correlations between the BCVA and the CMT was determined. Results: The mean BCVA improved significantly for all three agents (0.38 ± 0.22 logMAR units at the baseline to 0.27 ± 0.25 logMAR units) after the three monthly injections (p < 0.05, repeated ANOVA). For all cases, a moderate but significant correlation was found between the BCVA at day 7 and 1 month after the third injection (r = 0.58, p < 0.01; Spearman’s rank correlation). No significant correlation was found for bevacizumab (r = 0.09, p = 0.73), moderate correlation was found for ranibizumab (r = 0.42, p < 0.05), and a strong correlation was found for aflibercept (r = 0.83, p < 0.001) between the BCVA at day 7 and at 1 month after the third injection. The mean CMT improved significantly for all three agents (481.9 ± 96.3 μm at the baseline to 364.1 ± 116.0 μm after the three monthly injections, p < 0.05), and a moderate correlation was found for the three agents between CMT at day 7 to that at one month after the third anti-VEGF injection (r = 0.54, p < 0.01). A moderate correlation was found for all three agents between CMT at day 7 to that at one month after the third anti-VEGF injection (r = 0.68 for bevacizumab, r = 0.41 for ranibizumab and r = 0.53 for aflibercept, p < 0.05). Conclusions: The significant correlations between the results on day 7 to that one month after the third anti-VEGF treatment for DME indicates that the long-term effects of anti-VEGF therapy can be predicted by the short-term response. In addition, the results indicate that there may be differences in the effectiveness between the three anti-VEGF agents. Full article

(This article belongs to the Special Issue Recent Clinical Advances in Macular Degeneration and Retinal Diseases)

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9 pages, 1441 KiB

Open AccessArticle

Short-Term Morphofunctional Changes in Previously Treated Neovascular AMD Eyes Switched to Brolucizumab

by Pasquale Viggiano, Maria Oliva Grassi, Giacomo Boscia, Mariagrazia Pignataro, Giovanni Petruzzella, Enrico Borrelli, Teresa Molfetta, Giovanni Alessio and Francesco Boscia

J. Clin. Med. 2022, 11(19), 5517; https://doi.org/10.3390/jcm11195517 - 21 Sep 2022

Cited by 13 | Viewed by 1755

Abstract

The purpose of the study is to explore the morphofunctional fluctuations in eyes treated for neovascular AMD (nAMD) when treatment is switched from aflibercept or ranibizumab to brolucizumab. A total of 31 eyes of 31 patients with nAMD with type 1 macular neovascularization (MNV) were included. All patients were imaged using spectral domain optical coherence tomography (SD-OCT). The OCT acquisition was performed at the following visits: (i) “T1 visit” corresponding to the last follow-up examination in which an intravitreal injection of aflibercept or ranibizumab was performed before switching to brolucizumab because of the lack of improvement and (ii) “T2 visit” corresponding to the examination performed 1 month after T1, the latter visit corresponding to the day when a switch to brolucizumab injection was performed, (iii) and 1 month after the latter injection “(T3)”. The main outcome measures were: (1) central macular thickness (CMT), (2) choroidal vascularity index (CVI), (3) subfoveal choroidal thickness (CT), and best-corrected visual acuity (BCVA). Functional outcome showed significant differences at each time. Mean ± SD BCVA was 0.43 ± 0.12 LogMAR at T1 and 0.56 ± 0.16 LogMAR at T2 (p = 0.038). A significant improvement in BCVA was displayed at T3 (0.34 ± 0.21 LogMAR) as compared with T2 (p = 0.019). CMT analysis showed fluctuations three times. In detail, T2 displayed a thicker CMT in comparison with T1, although not statistically significant (p = 0.12). Contrariwise, T3 showed a thinner CMT in comparison with T2 (p = 0.002). Analyzing CVI among the three different times, the luminal choroidal area (LCA) and total choroidal area (TCA) showed significantly different values before and after switching to brolucizumab. T2 showed a significant reduction in both vessel lumen and total area compared with T1 (p = 0.032 and p = 0.046, respectively). Moreover, T3 showed a greater value of both LCA and TCA in comparison with T2 (p = 0.008 and p = 0.01, respectively). CT did not show significant differences at each time (p > 0.05). Our results reported early experiences on morphofunctional fluctuations in patients with nAMD who switched to brolucizumab. The anatomical impact of brolucizumab administration appears to result in choroidal vascular enlargement, accompanied by the resolution of subretinal fluid (SRF) and intraretinal fluid (IRF). Full article

(This article belongs to the Special Issue Recent Clinical Advances in Macular Degeneration and Retinal Diseases)

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Review

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20 pages, 2155 KiB

Open AccessReview

Relationship between Pachychoroid and Polypoidal Choroidal Vasculopathy

by Kenji Yamashiro, Yasuo Yanagi, Hideki Koizumi, Hidetaka Matsumoto, Chui Ming Gemmy Cheung, Fumi Gomi, Tomohiro Iida and Akitaka Tsujikawa

J. Clin. Med. 2022, 11(15), 4614; https://doi.org/10.3390/jcm11154614 - 8 Aug 2022

Cited by 19 | Viewed by 3211

Abstract

Previous clinical studies have suggested that pachychoroid can induce macular neovascularization (MNV) to develop pachychoroid neovasculopathy (PNV) and that PNV can progress to polypoidal choroidal vasculopathy (PCV). Recent studies based on the pachychoroid concept are now gradually revealing the true nature of, at least some part of, PCV. However, previous studies on PNV and/or PCV have used different frameworks for the classification of PNV, PCV, and neovascular age-related macular degeneration (nAMD). These have hampered the rapid overhaul of the understanding of PCV. Some investigators have assumed that all PCV is pachychoroid-driven whereas other investigators have classified PCV into “pachychoroid PCV” and “non-pachychoroid PCV”. Furthermore, since there is no consensus as to whether PNV includes PCV, some studies have included PCV with PNV, while other studies have excluded PCV from PNV. To address these gaps, we summarize previous studies on PCV and pachychoroid. Even before the proposal of the pachychoroid concept, previous studies had suggested that PCV could be divided into two subtypes, of which one was characterized by pachychoroid features. Previous studies had also provided keys to understand relationship between PCV and PNV. We here recommend a refined conceptual framework for future studies on PNV, PCV, and nAMD. Considering the current inconsistent understanding of PCV, we should be cautious about using the term PCV until we understand the true nature of PCV. Full article

(This article belongs to the Special Issue Recent Clinical Advances in Macular Degeneration and Retinal Diseases)

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Other

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12 pages, 621 KiB

Open AccessSystematic Review

Functional Outcomes of Brolucizumab-Induced Intraocular Inflammation Involving the Posterior Segment—A Meta-Analysis and Systematic Review

by Justus G. Garweg, Judith Keiper, Isabel B. Pfister and Christin Schild

J. Clin. Med. 2023, 12(14), 4671; https://doi.org/10.3390/jcm12144671 - 14 Jul 2023

Cited by 4 | Viewed by 1363

Abstract

Early poor outcomes of intraocular inflammation (IOI) after intravitreal brolucizumab (IVB) have negatively affected the use of brolucizumab in clinical routine. We wished to identify factors related to the treatment details of IOI involving the posterior segment resulting from IVB for neovascular AMD (nAMD), if these were reported in detail. Articles were retrieved from PubMed, Scopus, ClinicalTrials, and CENTRAL using the following search terms: <Brolucizumab> AND <AMD> AND <intraocular inflammation>. The risk of bias was rated using the JBI Critical Appraisal Tool. We included 31 reports (41 patients and 46 eyes). Patients were 75.9 ± 8.5 years, and 58.5% were female. IOI occurred 41.7 ± 37.5 (median 37.0) days after treatment initiation with 2.0 ± 1.3 (1–6) IVB injections. A mean change in visual acuity of −14.6 ± 21.0 (median −6.5) letters was reported. The mean time from first IOI signs to the initiation of any anti-inflammatory treatment was 3.3 ± 6.2 days, with 63% of the patients receiving systemic corticosteroids as standard treatment. Finally, a period effect was observed, with a change in visual acuity of −25.3 ± 27.1 and −2.6 ± 7.3 letters in the chronologically first and last third, respectively, of treated eyes (effect size: r = 0.71; p = 0.006). Functional outcomes markedly improved with increasing experience in managing IOI. Full article

(This article belongs to the Special Issue Recent Clinical Advances in Macular Degeneration and Retinal Diseases)

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