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Ophthalmology May 2020To summarize the rates of atrophy, risk factors, and atrophy-associated visual outcomes in patients with neovascular age-related macular degeneration (nAMD) who received...
TOPIC
To summarize the rates of atrophy, risk factors, and atrophy-associated visual outcomes in patients with neovascular age-related macular degeneration (nAMD) who received anti-vascular endothelial growth factor (VEGF) treatment for macular neovascularization (MNV).
CLINICAL RELEVANCE
Age-related macular degeneration is a leading cause of vision loss worldwide, and VEGF inhibitors are the primary treatment for nAMD. However, atrophy is observed frequently in eyes treated with anti-VEGF therapy, prompting questions regarding a causative role for these therapies in atrophy development.
METHODS
PubMed was searched for articles published in the past 5 years (January 1, 2014, through January 10, 2019). Studies including atrophy outcome(s) in patients with age-related macular degeneration who received anti-VEGF treatment were included. Review articles, retrospective studies, case reports or studies, preclinical studies, prevalence data reports, and non-English studies were excluded. Randomization was not required.
RESULTS
Overall, 145 studies were identified; 29 publications were included, with cohorts ranging from 8 to 1185 eyes. Imaging methods used to assess atrophy varied across studies. All studies confirmed the occurrence of atrophy, and when available, longitudinal data from the included studies demonstrated an increase in atrophy incidence over time. Key risk factors or phenotypes associated with atrophy were fellow eye atrophy, reticular pseudodrusen, increased injections, and type 3 lesion. In addition, visual acuity loss was noted with foveal atrophy.
DISCUSSION
All studies demonstrated that atrophy occurs in the context of MNV treated with anti-VEGF therapy; however, it is not clear whether anti-VEGF treatment is causative of atrophy versus being associated with atrophy development. The included studies were not designed or powered to assess atrophy as a primary outcome. In addition, it is difficult to determine whether prognostic factors directly affect atrophy. Furthermore, patient populations in clinical trials do not necessarily represent real-world patients. Although phenotypes and risk factors may help to identify those at greater risk of atrophy developing, it is important to recognize that adequately treating exudative MNV remains the best option to optimize vision outcomes in patients with nAMD, particularly given the risk of vision loss with undertreatment observed in the real world.
Topics: Angiogenesis Inhibitors; Atrophy; Choroidal Neovascularization; Humans; Intravitreal Injections; Photoreceptor Cells, Vertebrate; Randomized Controlled Trials as Topic; Retinal Pigment Epithelium; Retrospective Studies; Risk Factors; Vascular Endothelial Growth Factor A; Wet Macular Degeneration
PubMed: 32081493
DOI: 10.1016/j.ophtha.2019.11.010 -
The Journal of Maternal-fetal &... Jan 2022Retinopathy of prematurity (ROP) is a multifactorial retinal disorder characterized by an abnormal vascular development of the retina of the preterm infants. Carotenoids... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Retinopathy of prematurity (ROP) is a multifactorial retinal disorder characterized by an abnormal vascular development of the retina of the preterm infants. Carotenoids are natural pigments that are synthesized by all plants and some microorganisms where they play a role in photoprotection and coloration. Lutein and zeaxanthin (L/Z) are two carotenoids identified as the major components of the macular pigment. Recently it has been suggested that lutein and its isomer zeaxanthin may act as antioxidant agents and that they may prevent ROP.
OBJECTIVE
The primary objective of this study is to assess the safety and effectiveness of oral lutein in the prevention of retinopathy of prematurity in preterm neonates.
STUDY DESIGN
We conducted a systematic search for randomized or quasi-randomized controlled trials without any language or publication year restriction. The studies have to recruit preterm neonates ≤32 completed weeks of gestation and to compare the administration of oral L/Z at any dosage or duration, versus placebo in order to prevent ROP.
RESULT
Data from three RCT with a total of 406 participants failed to show any reduction in ROP incidence nor the risk of BPD, sepsis, NEC and mortality. It may reduce the number of transfusions but this result has to be assessed in a separate ad hoc trial.
Topics: Dietary Supplements; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Lutein; Retinopathy of Prematurity
PubMed: 32041442
DOI: 10.1080/14767058.2020.1712700 -
Clinical & Experimental Ophthalmology Jan 2020In classic familial adenomatous polyposis (FAP) adenomas become malignant. Congenital hypertrophy of the retinal pigment epithelium (CHRPE) is a retinal pigmented lesion...
In patients with a positive family history of familial adenomatous polyposis can the condition be diagnosed from the presence of congenital hypertrophy of the retinal pigment epithelium detected via an eye examination: A systematic review.
In classic familial adenomatous polyposis (FAP) adenomas become malignant. Congenital hypertrophy of the retinal pigment epithelium (CHRPE) is a retinal pigmented lesion and is the earliest and most common potential extraintestinal manifestation of FAP. This review aims to summarize and analyse all of the published data on CHRPE in patients with classic FAP and then ascertain whether these patients should undergo a relatively cheap and non-invasive dilated fundus examination to screen for CHRPE. Adhering to Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines our database search identified 102 relevant articles of which 13 were selected for further analysis. The percentage of FAP patients with CHRPE was found to be 80.00%, whereas the percentage of at-risk patients with CHRPE was 31.12%. Despite various statistically significant findings, CHRPE alone cannot be used as a surrogate for diagnosing FAP in those with a positive family history. The authors advocate a combined approach of eye examinations, colonoscopy and genetic testing.
Topics: Adenomatous Polyposis Coli; Colorectal Surgery; Humans; Hypertrophy; Physical Examination; Pigment Epithelium of Eye; Predictive Value of Tests
PubMed: 31525261
DOI: 10.1111/ceo.13643 -
Ophthalmology Sep 2019Systematic review and meta-analysis of the natural history of autosomal recessive Stargardt disease (STGD1). (Meta-Analysis)
Meta-Analysis
TOPIC
Systematic review and meta-analysis of the natural history of autosomal recessive Stargardt disease (STGD1).
CLINICAL RELEVANCE
Controversy exists regarding the progression pattern of atrophic lesions secondary to STGD1, and the reported growth rates vary widely among studies.
METHODS
We searched in 6 literature databases up through March 15, 2019, to identify studies that monitored atrophy progression by fundus autofluorescence in untreated eyes with STGD1 for 6 months or more. We analyzed both study- and individual-level data from the included studies using 3 models: the area linear model (ALM), radius linear model (RLM), and area exponential model (AEM), in which the area, radius, and natural log-transformed area changes linearly with time, respectively. A horizontal translation factor was added to each dataset to correct for different participants' entry times into the studies. The best model was determined by the predicted age of lesion onset and dependence of growth rates on baseline lesion sizes. The risk of bias was assessed using the Newcastle-Ottawa scale.
RESULTS
Of 3158 articles screened, 7 studies (564 eyes) met our inclusion criteria. Cumulative study- and individual-level datasets fit along a straight line in the RLM after introducing horizontal translation factors to correct for different entry times (r = 0.99 and r = 0.93, respectively). The growth rate of effective lesion radius was 0.104 mm/year (95% confidence interval, 0.086-0.123 mm/year). The age of atrophy onset predicted by the RLM (22.7±5.0 years) was comparable to the reported age at onset of symptoms (22.1±3.1 years); in contrast, the predictions by the ALM and AEM deviated from this number by more than 5 years. Based on the individual-level data, the effective radius growth rate was independent of the baseline lesion size (r = 0.06); in comparison, the growth rates of area and natural log-transformed area were significantly dependent on the baseline lesion size (r = 0.47 and r = -0.33, respectively).
CONCLUSIONS
The progression of STGD1 lesions followed the RLM in both study- and individual-level data. The effective radius growth rate of atrophic lesions could serve as a reliable outcome measure to monitor STGD1 progression.
Topics: Databases, Factual; Disease Progression; Female; Geographic Atrophy; Humans; Linear Models; Male; Optical Imaging; Retinal Pigment Epithelium; Stargardt Disease; Tomography, Optical Coherence; Visual Acuity
PubMed: 31227323
DOI: 10.1016/j.ophtha.2019.05.015 -
Ophthalmology. Retina Sep 2019Age-related macular degeneration (AMD) is highly prevalent among the elderly. We systematically reviewed the literature to provide an overview of ultra-widefield imaging... (Meta-Analysis)
Meta-Analysis
TOPIC
Age-related macular degeneration (AMD) is highly prevalent among the elderly. We systematically reviewed the literature to provide an overview of ultra-widefield imaging (UWFI) of peripheral retinal lesions in AMD.
CLINICAL RELEVANCE
Information regarding retinal characteristics and prevalence of AMD is based mainly on studies using color photography of the central retina, where early and potentially severe manifestations of the disease are found. However, this approach has the effect of neglecting the periphery. Studies using UWFI provide new evidence to show that clinical features associated with AMD are not exclusive to the area of the macula.
METHODS
Eligible studies had to detect lesions of the peripheral retina (based on the original definition of a standard macular grid, with the addition of 2 zones classed as peripheral) using UWFI in eyes with AMD. Ultra-widefield imaging included pseudocolor photography, fundus autofluorescence, fluorescein angiography, and indocyanine green angiography. Eligibility was restricted to human participants and studies written in English. We searched the bibliographic databases PubMed, the Cochrane Library, EMBASE, and the Web of Science on March 27, 2018. We calculated the prevalence of peripheral findings in eyes with AMD and performed similar meta-analyses on the healthy control group. A random-effects model was used because of possible study heterogeneity.
RESULTS
Twelve studies were eligible for the review, which included 3261 or more eyes. Studies were clinic based, apart from 1 study that was a random population sample of individuals 62 years of age or older. Studies were cross-sectional in nature, apart from 1 case-control study. The peripheral lesions most commonly observed were drusen, atrophy, and changes to the retinal pigment epithelium. In eyes with AMD, peripheral lesions were found in 82.7% of eyes (confidence interval, 78.4%-86.7%) compared with 33.3% of healthy eyes (confidence interval, 28.3%-38.5%).
CONCLUSIONS
Peripheral changes were found to be highly prevalent in eyes with AMD, supporting the claim that the disease is panretinal and not macula only. The clinical significance of peripheral lesions in AMD remains incompletely understood, and therefore, further UWFI studies are recommended.
Topics: Aged; Aged, 80 and over; Female; Humans; Macular Degeneration; Male; Middle Aged; Optical Imaging; Retina
PubMed: 31167730
DOI: 10.1016/j.oret.2019.04.014