Investigation of genetic base in the treatment of age-related macular degeneration.

PURPOSE: To determine whether gene polymorphisms which are associated with age-related macular degeneration (AMD) influence treatments' response and specifically the antioxidant supplementation in dry AMD patients, as well as the anti-vascular endothelial growth factor (anti-VEGF) therapy in neovascular AMD patients. METHODS: A total of 170 patients with dry AMD and 52 neovascular AMD patients were genotyped for the following single nucleotide polymorphisms (SNPs): rs1061170/Y402H in CFH gene, rs10490924/A69S in ARMS2 gene, rs9332739/E318D and rs547154/IVS10 in C2 gene, and rs4151667/L9H and rs2072633/IVS17 in CFB gene. Treatment response was evaluated by comparing visual acuity and optical coherence tomography between baseline and at the end of the treatment. RESULTS: Τhe CFH/Y402H variant was associated with the response to antioxidants in dry AMD patients. Carriers of one or two CFH risk alleles displayed a lower chance of responding compared to those with no risk allele. No association of antioxidants' response and ARMS2/A69S genotype was identified. The analysis of the C2 and CFB genetic variants (protective SNPs) revealed that antioxidant supplementation was much more effective in protective SNP carriers. In neovascular AMD patients, the analysis indicated that Y402H homozygous patients were less likely to respond to anti-VEGF therapy compared to heterozygous. Regarding the ARMS2/A69S genotype, carriers of the risk variant experienced significantly worse treatment outcome compared to wild-type patients. CONCLUSION: In AMD patients, the efficacy of the antioxidant supplementation and the anti-VEGF therapy appears to differ by genotype. The detection of genetic variants, associated with treatment responsiveness, could lead to improved visual outcomes through genotype-directed therapy.

Comparative analysis of the development of collateral vessels in macular edema due to branch retinal vein occlusion following grid laser or ranibizumab treatment.

PURPOSE: To evaluate the differences in the development of collateral vessels in patients with macular edema due to branch retinal vein occlusion (BRVO) after treatment with either grid laser or ranibizumab (RNB). METHODS: Comparative study including patients with macular edema due to acute BRVO and best-corrected visual acuity (BCVA) between 20/40 and 20/200. The sample was divided into two groups according to the treatment applied: laser group, including eyes treated with Argon laser when retinal hemorrhages were sufficiently absorbed to perform the treatment, and RNB group, including patients treated initially with one monthly intravitreal injection for a period of 3 months of RNB and more injections according to need thereafter. Before treatment patients in both groups, received a complete ophthalmic examination, including BCVA, fundus examination, optical coherence tomography, fundus color photography, and fundus fluorescein angiography (FA). This same protocol of examination was repeated in every visit after treatment, except FA that was only repeated every 3 months. The detection of the collateral vessels was done by two experienced examiners based on the analysis of the early phase of the FA. If there was a discrepancy in their judgment, the criterion of a third examiner evaluating the FA was considered. RESULTS: Mean baseline BCVA was 0.86±0.26 and 0.82±0.25 (logMAR [logarithm of the minimum angle of resolution]) in the RNB and laser groups, respectively (P=0.83). At the end of the follow-up, mean BCVA was 0.38±0.18 and 0.64±0.33 (logMAR) in the RNB and laser groups, respectively. The difference in the final BCVA between both groups was statistically significant (P=0.002). Collaterals developed in both groups; 66.67% of patients (14 out of 21 patients) developed collaterals at a mean time of 6.14±2.60 months after diagnosis in the RNB group, and 68.18% (16 out of 22 patients) developed collaterals in the laser group at a mean time of 6.2±1.97 months after diagnosis. No statistically significant differences between groups were found in the number of cases developing collateral vessels (P=1.00) as well as in the time required for such development (P=0.947). CONCLUSION: The use of RNB for the treatment of macular edema due to BRVO does not seem to alter the development of collateral vessels. Future studies with larger samples are required to confirm these outcomes.

Ranibizumab for diabetic macular edema difficult to treat with focal/grid laser.

BACKGROUND: To evaluate the efficacy of intravitreal injections of ranibizumab in patients with diabetic clinically significant macular edema (CSME), when further focal or grid laser was considered to be unsafe. METHODS: In this retrospective, interventional case study, intravitreal injections of ranibizumab were performed in 16 eyes (ten patients) suffering from diabetic retinopathy with CSME. All patients had been treated in the past with focal or grid laser. Additional photocoagulation could not be performed because the leaking points were very close to the avascular zone, and there was also a perifoveal capillary dropout. The patients underwent three injections (months 0, 1 and 2) and were followed monthly. Reinjection was performed if central retinal thickness (CRT) was ≥250 µm associated with fluorescein leakage involving the center of the macula. RESULTS: The patients underwent a median of seven injections (range 6-9) and the median follow-up time was 11 months (range 9-15). The median best-corrected visual acuity (BCVA) was 0.85 logMAR at baseline and 0.54 logMAR at the end of the follow-up time (p = 0.018). BCVA improved in seven eyes (43.75%), remained stable in eight (50%) and decreased in one eye (6.25%). The median CRT decreased from 409.5 µm at baseline to 272 µm at the end of the follow-up time (p = 0.0002). No ocular or systemic adverse events were reported. CONCLUSIONS: For a median follow-up time of 11 months, the treatment with intravitreal injections of ranibizumab resulted in stabilization or improvement of the visual acuity in the vast majority of patients with diabetic maculopathy and CSME, when further focal or grid laser was considered to be unsafe.

Intravitreal ranibizumab treatment of macular choroidal neovascularization secondary to angioid streaks: one-year results of a prospective study.

PURPOSE: The purpose of this study was to evaluate the efficacy of intravitreal ranibizumab in eyes with macular choroidal neovascularization secondary to angioid streaks. METHODS: A prospective interventional case series was conducted on eyes with macular choroidal neovascularization, secondary to angioid streaks, treated by repeated injections of intravitreal ranibizumab (0.5 mg) and completing a follow-up time of 1 year. The outcome measures were best-corrected visual acuity, greatest lesion height as evaluated by optical coherence tomography, and lesion size as assessed by fluorescein angiography. RESULTS: Over a 16-month period, we treated 15 consecutive eyes. The average number of injections was 7.1 +/- 0.5. Mean best-corrected visual acuity was improved from 20/100 to 20/50 (P = 0.006). Best-corrected visual acuity either improved or stabilized in 14 eyes (93.3%). At baseline, 3 of the 15 eyes (20%) had a best-corrected visual acuity of >or=20/50 compared with 10 eyes (66.7%) at the end of the first year. Fourteen eyes (93.3%) presented reduction in greatest lesion height and stabilization or reduction in lesion size. The mean greatest lesion height was decreased from 377.3 +/- 139.7 microm to 270.2 +/- 88.6 microm (P < 0.001). CONCLUSION: Intravitreal ranibizumab is highly effective in improving or stabilizing vision and lesion morphology in patients with macular choroidal neovascularization secondary to angioid streaks.

Foveal thickness after phacoemulsification as measured by optical coherence tomography.

BACKGROUND: Despite a significant body of research, no consistency on postoperative foveal thickness as measured by optical coherence tomography (OCT), can be recorded. The purpose of our study was to evaluate the effect of uncomplicated cataract surgery in the thickness of the retina in the foveal area during the early postoperative period. METHODS: In a prospective study, 79 eyes were assessed by OCT, on day 1, and weeks 2 and 4 after uncomplicated phacoemulsification with intraocular lens implantation in the Athens University Clinic. The outcome measure was the thickness of the retina in the foveal area. RESULTS: The thickness of the retina preoperatively is significantly smaller (150.4 +/- 18.8) (p < 0.05) than the thickness of the retina on day 1 (171.8 +/- 21) and week 2 (159.7 +/- 19) and returned to the initial levels on week 4 (152 +/- 17.1). The estimated correlation coefficients between preoperative and postoperative thickness of the retina were significant (p < 0.05). Conversely, no association was found between postoperative visual acuity and thickness of the retina, neither between the phacoemulsification energy and retinal thickness. Operation time, although inversely related with postoperative visual acuity, was not associated with the thickness of the retina. CONCLUSIONS: Following phacoemulsification, an increase in the foveal thickness was detected in the early postoperative period, quantified and followed up by OCT. The foveal thickness returned to the preoperative level, 1 month following surgery in our study. No association was shown between intraoperative parameters and increased postoperative retinal thickness.