Long-Term Visual Outcomes in Exudative Age-Related Macular Degeneration Patients With Unanticipated Gaps in Therapy.

BACKGROUND AND OBJECTIVES: This study's objective was to describe long-term visual outcomes of patients with age-related macular degeneration (AMD) treated with intravitreal anti-vascular endothelial growth factor injections who were lost to follow-up and then resumed treatment with anti-vascular endothelial growth factor injections. MATERIALS AND METHODS: This was a retrospective cohort study of eyes with at least 7 years of follow-up following the initiation of treatment for wet AMD with and without gaps in therapy. RESULTS: The baseline mean logMAR visual acuity was 0.65 ± 0.5 (Snellen acuity 20/89) in eyes with gaps in therapy and 0.53 ± 0.3 (20/68) in eyes without gaps. In the initial 7-year follow-up period, the eyes with gaps in therapy had significantly worse visual acuity (P < .001) and this remained significant when accounting for baseline visual acuity (P < .001). CONCLUSIONS: Gaps in intravitreal injection therapy for exudative AMD were negatively associated with visual acuity. Adherence to therapy is important to address in the care of patients with exudative AMD. [Ophthalmic Surg Lasers Imaging Retina 2022;53:481-489.].

Need for Additional Glaucoma Surgery and Complications Following Glaucoma Drainage Device Surgery.

PRCIS: In this longitudinal study of patients with open-angle (OAG), pseudoexfoliative (PXE), or neovascular glaucoma (NVG) receiving glaucoma drainage devices (GDD), posttube cumulative rates of reoperation, corneal graft, and visually threatening complications (VT-complications) increased beyond 5 years and were not significantly affected by glaucoma type. PURPOSE: To study the need for additional glaucoma surgery and development of complications after first GDD surgery in eyes with primary OAG, PXE, or NVG glaucoma. PATIENTS AND METHODS: There were 306 eyes with OAG (n=185), PXE (n=60), or NVG (n=61) glaucoma who received a first GDD between 1996 and 2017. Outcomes including glaucoma reoperation, corneal graft procedure, and VT-complications after GDD were measured. Kaplan-Meier analysis was used to compare cumulative rate of reaching outcomes over time after GDD placement among the 3 glaucoma groups. RESULTS: When comparing the OAG, PXE, and NVG groups, there were no significant differences in post-GDD cumulative rates of reoperation (P=0.33), corneal graft (P=0.26), or VT-complications (P=0.65) over time. For all eyes, the overall cumulative rates for each outcome measure increased beyond 5 years, and specific Kaplan-Meier rates (5-y, 10-y) included: reoperation (16%, 25%), corneal graft (6%, 12%), VT-complications (9%, 14%). When comparing specific GDDs, the Ahmed FP7 had a higher cumulative reoperation rate over time compared with the Baerveldt 350 (P=0.019). CONCLUSION: Glaucoma type did not significantly affect post-GDD cumulative rates of reoperation, corneal graft, and VT-complication among the OAG, PXE, and NVG groups. For all eyes, cumulative rates of reoperation, corneal graft, and VT-complications increased beyond 5 years. The Ahmed FP7 had a significantly higher cumulative reoperation rate compared with the Baerveldt 350 over time.

Long-Term Follow-up of Patients with Exudative Age-Related Macular Degeneration Treated with Intravitreal Anti-Vascular Endothelial Growth Factor Injections.

PURPOSE: To determine the long-term visual outcomes and intravitreal injection burden of patients with exudative age-related macular degeneration (AMD) treated with intravitreal anti-vascular endothelial growth factor (VEGF) injections. DESIGN: Retrospective cohort study. PARTICIPANTS: Patients with exudative AMD treated with intravitreal anti-VEGF injections with annual office visits for at least 7 years. METHODS: Snellen visual acuity was measured at baseline and then annually until the last year of follow-up. The number of injections was recorded on an annual basis during each year of follow-up. MAIN OUTCOME MEASURES: The change in the frequency of injections over time along with the change in visual acuity each year from the baseline visit through 7 years. RESULTS: During this period, 533 eyes of 429 patients were treated for exudative AMD. Of these, 391 eyes (73%) met the inclusion criteria of annual office visits and received a mean of 5.8 ± 2.5 intravitreal injections per year. The baseline mean visual acuity was 0.6 ± 0.5 logarithm of the minimum angle of resolution (logMAR; Snellen equivalent, 20/80), and the 7-year visual acuity was 0.8 ± 0.6 logMAR (Snellen equivalent, 20/126; P < 0.0001). When compared with the 142 eyes that did not undergo an office visit for a continuous 12-month period, eyes with annual office visits showed similar baseline mean visual acuity (0.7 logMAR vs. 0.6 logMAR; P = 0.2102), but more injections per year (P < 0.0001). Of the 533 total eyes, 124 eyes (23%) maintained better than 20/40 visual acuity at 7 years. These eyes received more injections overall per year (6.5 vs. 5.5 injections per year; P = 0.0007). CONCLUSIONS: In a real-world setting, eyes that maintained consistent, long-term follow-up received significantly more intravitreal injections per year than eyes with inconsistent follow-up. Eyes with 20/40 or better vision at study conclusion received more injections per year than eyes with worse than 20/40 vision.

TEN-YEAR FOLLOW-UP OF PATIENTS WITH EXUDATIVE AGE-RELATED MACULAR DEGENERATION TREATED WITH INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR INJECTIONS.

PURPOSE: To identify the visual acuity outcomes of patients with age-related macular degeneration treated with intravitreal anti-vascular endothelial growth factor injections over a 10-year period. METHODS: This was a retrospective, cohort study of eyes with exudative age-related macular degeneration that received ≥2 intravitreal anti-vascular endothelial growth factor injections and had at least 10 years of follow-up after the initiation of treatment. Snellen visual acuity was recorded at baseline and then annually until the last year of follow-up. Optical coherence tomography data were collected at the time of treatment initiation and at the last examination visit. A subanalysis was performed on patients who continued to receive anti-vascular endothelial growth factor therapy using a modified treat and extend protocol versus those who discontinued treatment for longer than 1 year. RESULTS: One hundred thirty eyes of 115 patients met the inclusion criteria. The mean follow-up after treatment initiation was 11.1 ± 0.7 years. Eyes received an average of 45.1 ± 32.3 intravitreal injections in total and a mean of 5 to 7 injections per year. The baseline mean logMAR visual acuity was 0.61 ± 0.5 (Snellen acuity 20/81), and the final mean logMAR visual acuity was 0.88 ± 0.7 (20/152, P value = <0.0001). There were 40 eyes that received at least one injection every year. These eyes did not have a significant change in visual acuity between the baseline and final examinations 0.47 ± 0.4 (20/59 vs. 0.58 ± 0.5 [20/76, P = 0.28]), whereas the eyes that did not receive at least one injection every year saw a significant decline in visual acuity 0.67 ± 0.5 (20/94 vs. 1.01 ± 0.7 [20/205, P < 0.0001]). CONCLUSION: Eyes with exudative age-related macular degeneration that received intravitreal injections every year had stable visual acuity over a 10-year period. Continuous intravitreal anti-vascular endothelial growth factor therapy may stabilize visual acuity for 10 years and potentially longer.

Printable photonic crystals with high refractive index for applications in visible light.

Nanoimprint lithography (NIL) of functional high-refractive index materials has proved to be a powerful candidate for the inexpensive manufacturing of high-resolution photonic devices. In this paper, we demonstrate the fabrication of printable photonic crystals (PhCs) with high refractive index working in the visible wavelengths. The PhCs are replicated on a titanium dioxide-based high-refractive index hybrid material by reverse NIL with almost zero shrinkage and high-fidelity reproducibility between mold and printed devices. The optical responses of the imprinted PhCs compare very well with those fabricated by conventional nanofabrication methods. This study opens the road for a low-cost manufacturing of PhCs and other nanophotonic devices for applications in visible light.

Differential Receptor for Advanced Glycation End Products Expression in Preeclamptic, Intrauterine Growth Restricted, and Gestational Diabetic Placentas.

PROBLEM: Receptor for advanced glycation end products (RAGE) is a receptor implicated in the modulation of inflammation. Inflammation has been associated with pregnancy pathologies including preeclampsia (PE), intrauterine growth restriction (IUGR), and gestational diabetes mellitus (GDM). Our objective was to examine placental RAGE expression in PE, IUGR, and GDM complications. METHOD OF STUDY: Human placental tissues were obtained for RAGE determination using Q-PCR, immunohistochemistry, and Western blot. Invasive trophoblast cells were cultured and treated with AGES for RAGE activation studies. RESULTS: Compared to control placenta, we observed: (i) decreased RAGE gene expression during GDM, (ii) increased RAGE protein in the PE placenta, and (iii) decreased RAGE protein in the IUGR placenta. In trophoblast cells exposed AGEs, we observed: (i) decreased trophoblast invasion, (ii) increased c-Jun N-terminal kinases (JNK) and Extracellular signal-regulated kinases (ERK), and (iii) increased TNF-α and IL-1ß secretion. CONCLUSION: We conclude that placental RAGE is activated during PE and that RAGE-mediated inflammation in the trophoblast involves increased pro-inflammatory cytokine secretion.

Light-assisted, templated self-assembly of gold nanoparticle chains.

We experimentally demonstrate the technique of light-assisted, templated self-assembly (LATS) to trap and assemble 200 nm diameter gold nanoparticles. We excite a guided-resonance mode of a photonic-crystal slab with 1.55 µm laser light to create an array of optical traps. Unlike our previous demonstration of LATS with polystyrene particles, we find that the interparticle interactions play a significant role in the resulting particle patterns. Despite a two-dimensionally periodic intensity profile in the slab, the particles form one-dimensional chains whose orientations can be controlled by the incident polarization of the light. The formation of chains can be understood in terms of a competition between the gradient force due to the excitation of the mode in the slab and optical binding between particles.

Optical stretching as a tool to investigate the mechanical properties of lipid bilayers.

Measurements of lipid bilayer bending modulus by various techniques produce widely divergent results. We attempt to resolve some of this ambiguity by measuring bending modulus in a system that can rapidly process large numbers of samples, yielding population statistics. This system is based on optical stretching of giant unilamellar vesicles (GUVs) in a microfluidic dual-beam optical trap (DBOT). The microfluidic DBOT system is used here to measure three populations of GUVs with distinct lipid compositions. We find that gel-phase membranes are significantly stiffer than liquid-phase membranes, consistent with previous reports. We also find that the addition of cholesterol does not alter the bending modulus of membranes composed of a monounsaturated phospholipid.

Light-assisted, templated self-assembly using a photonic-crystal slab.

We experimentally demonstrate the technique of light-assisted, templated self-assembly (LATS). We excite a guided-resonance mode of a photonic-crystal slab with 1.55 µm laser light to create an array of optical traps. We demonstrate assembly of a square lattice of 520 nm diameter polystyrene particles spaced by 860 nm. Our results demonstrate how LATS can be used to fabricate reconfigurable structures with symmetries different from traditional colloidal self-assembly, which is limited by free energetic constraints.

Optical stretching of giant unilamellar vesicles with an integrated dual-beam optical trap.

We have integrated a dual-beam optical trap into a microfluidic platform and used it to study membrane mechanics in giant unilamellar vesicles (GUVs). We demonstrate the trapping and stretching of GUVs and characterize the membrane response to a step stress. We then measure area strain as a function of applied stress to extract the bending modulus of the lipid bilayer in the low-tension regime.

Optical trapping of metal-dielectric nanoparticle clusters near photonic crystal microcavities.

We predict the formation of optically trapped, metal-dielectric nanoparticle clusters above photonic crystal microcavities. We determine the conditions on particle size and position for a gold particle to be trapped above the microcavity. We then show that strong field redistribution and enhancement near the trapped gold nanoparticle results in secondary trapping sites for a pair of dielectric nanoparticles.

Light-assisted templated self assembly using photonic crystal slabs.

We explore a technique which we term light-assisted templated self-assembly. We calculate the optical forces on colloidal particles over a photonic crystal slab. We show that exciting a guided resonance mode of the slab yields a resonantly-enhanced, attractive optical force. We calculate the lateral optical forces above the slab and predict that stably trapped periodic patterns of particles are dependent on wavelength and polarization. Tuning the wavelength or polarization of the light source may thus allow the formation and reconfiguration of patterns. We expect that this technique may be used to design all-optically reconfigurable photonic devices.