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Age-related macular degeneration(ARMD)is a neurodegenerative disease associated with oxidative stress. It is characterized by progressive death of photoreceptors and retinal pigment epithelium(RPE), and is one of the leading causes of irreversible loss of central vision in patients over the age of 65 years old. MicroRNA(miRNA)is a class of regulatory short-chain non-coding RNA that can bind and inhibit multiple gene targets in the same biological pathway. This unique property makes microRNA an ideal target for exploring the pathogenesis, diagnosis and treatment of non-exudative ARMD. Previous studies have found that the pathogenesis of non-exudative ARMD involves age, genetics, environment, oxidative stress, lipid metabolism, autophagy and immunity. However, the exact mechanisms have not been fully clarified. As biomarkers of non-exudative ARMD, miRNA play a role in oxidative stress and lipid metabolism. This article summarizes the role of various miRNA in targeting Nrf2 and HIF-1α to inhibit hypoxia-related angiogenesis signaling, thereby affecting oxidative stress. Additionally, miRNA regulate lipid uptake and the expression of ABCA1 in RPE and macrophages, thereby influencing lipid metabolism. This deepens the understanding of the role of miRNA in oxidative stress and lipid metabolism in non-exudative ARMD, and provides directions for further improving the understanding of the pathogenesis and prevention of non-exudative ARMD.
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AIM: To analyze the causality between type 2 diabetes mellitus(T2DM)and age-related macular degeneration(ARMD)based on two-sample Mendelian randomization(MR).METHODS: T2DM and ARMD samples were extracted from the FinnGen database. Inverse variance weighted(IVW)was used as the main analysis method, MR-Egger and weighted median(WM)as supplementary methods to analyze the potential relationship between them. In addition, Cochran Q test and MR-Egger intercept were also used to analyze the sensitivity, and the P-value was used as the index of research results.RESULTS: IVW showed that T2DM was associated with the incidence of exudative ARMD(OR=1.14, 95%CI 1.01～1.28, P=0.021), but it was not significantly associated with the incidence of atrophic ARMD(OR=0.96, 95%CI 0.86～1.07, P=0.554). The results of sensitivity analysis confirmed that there was no heterogeneity and pleiotropy in this study, and the results were reliable.CONCLUSION: There is a causal relationship between T2DM and exudative ARMD. Considering the high rate of blindness caused by ARMD, it is of great significance to recognize and control the risk factors of ARMD to reduce its prevalence rate and early diagnosis and treatment.
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Purpose: Age-related macular degeneration (AMD) is a disease of the macula that significantly affects eyesight and leads to irreversible central vision loss. Recent studies have demonstrated that angiogenesis is the most important mechanism of AMD development. It is associated with extracellular remodeling involving different proteolytic systems, among them matrix metalloproteinases (MMPs), which play an essential role in the etiopathogenesis of AMD. The main objective of the present study was to determine the relationship between exudative AMD and MMP-2 (-1306 C/T) rs243865 polymorphism. Methods: The study enrolled 267 patients with exudative AMD and 318 controls. DNA was extracted from peripheral venous blood leukocytes by commercial kits. Genotyping of MMP-2 (-1306 C/T) rs243865 was carried out using real-time polymerase chain reaction method. Results: The analysis of MMP-2 (-1306 C/T) polymorphism did not reveal any differences in the distribution of CC, CT, and TT genotypes between the exudative AMD and control groups: 58.8%, 31.5% and 9.7% vs. 59.75%, 33.96% and 6.29%, respectively, P = 0.287). When the study population was subdivided into age groups, MMP-2 (-1306 C/T) rs243865 CT genotype showed 5.7-fold increased the risk of exudative AMD development compared to CC and TT genotypes together in younger (<65 years) males group (P = 0.05). Conclusion: MMP-2 (-1306 C/T) polymorphism is associated with exudative AMD development in younger males.
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Purpose: To evaluate preliminarily and compare the level of plasmatic biomarkers of vascular risk in patients with and without exudative age-related macular degeneration (ARMD) and to relate it to vascular resistance alterations in the ophthalmic artery (OA), central retinal artery (CRA), posterior temporal ciliary artery (PTCA), and posterior nasal ciliary artery (PNCA). Methods: Color Doppler imaging of the OA, CRA, PTCA, and PNCA was performed in 30 eyes of 30 cataract patients (control group) as well as in 30 eyes of 30 patients with naive exudative ARMD (study group), measuring the peak systolic velocity, end-diastolic velocity (EDV), and Pourcelot resistive index (RI). Likewise, in both groups, a blood test was performed to determine the plasmatic levels of homocysteine, C-reactive protein (CRP), B12 vitamin, and folic acid. Results: A positive and significant correlation was found between the level of CRP and RI of the OA in the ARMD group (r = 0.498, P = 0.005), with an increased RI in all arteries compared to controls, although differences only reached statistical significance for the PTCA (P = 0.035). Likewise, a significantly lower EDV for the CRA was found in ARMD eyes compared to controls (P = 0.041). In the study group, significantly higher plasmatic levels of homocysteine (P = 0.042) and CRP (P = 0.046) were found. In contrast, no significant differences were found between groups in the levels of folic acid (P = 0.265) and B12 vitamin (P = 0.520). Conclusion: The decrease of the choroidal perfusion related to hyperhomocysteinemia, and increase in the CRP plasmatic levels may play an etiological role on the exudative ARMD. This should be investigated in future studies with larger samples of patients.
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@#AIM: To study the clinical efficacy of Conbercept intravitreal injection(0.5mg/0.05mL)in the treatment of exudative age-related macular degeneration(ARMD). <p>METHODS: Forty-five patients(45 eyes)with exudative age-related macular degeneration diagnosed in our hospital from July 2015 to January 2016 were retrospectively studied. A monthly intravitreal injection of conbercep was carried out. After 3-month injection, conbercep was given if necessary(3+PRN), and all patients were followed up for 2a. Before and after treatment, the intraocular pressure, the best corrected visual acuity(BCVA), central macular thickness(CMT)changes were observed. <p>RESULTS: The BCVA at 1, 2, 3mo, 1 and 2a after treatment was better than that before treatment(<i>t</i>=5.208, 5.111, 4. 323, 4.701, 5.156; <i>P</i><0.05). CMT was significantly lower than before treatment(<i>t</i>=3.807, 4.556, 2.841, 2.707, 3.145; <i>P</i><0.05). <p>CONCLUSION: Conbercept injection, as 3+PRN, can effectively improve visual acuity, reduce macular edema.
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· AIM:To evaluate the effectiveness and safety of Conbercept for exudative age-related macular degeneration (eAMD) systematically,in order to provide evidence-based reference for clinical use.· METHODS:We performed a comprehensive search for the randomized controlled trials(RCTs)about conbercept trail group vs control group in the treatment of eAMD published by November,2017 from PubMed,Cochrane Library,CNKI and Wanfang Database.Studies obtained from eligible database were filtered according to modified Jadad scale,and data were retrieved from those studies for further analysis.Then,we performed a Meta-analysis using RevMan 5.3 and Stata 12.0 statistical software.· RESULTS:A total of 12 RCTs were included,involving 924 patients.The results of Meta-analysis showed that the central macular retinal thickness (CMT) markedly decreased at 1,3,6 and 12mo after treatment;visual acuity at 3 and 6mo and quality of life (QOL) at 6mo were significantly improved;total effective rate of treatment at increased,which was statistically different to control group (P＜0.05),but rate of adverse reaction was similar (P＞0.05).The long-term effect was better than control group.· CONCLUSION:The existing evidence supports that conbercept has good therapeutic efficacy and safety for eAMD.It can significantly reduce the CMT,improve the visual acuity,the quality of life and the total efficiency of treatment,and the long-term effect is better than control group.
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AIM:To investigate the effect of intravitreal ranibizumab ( IVR) in the treatment of exudative age-related macular degeneration ( AMD ) with serous retinal pigment epithelium detachment ( SPED) in elderly patients. ·METHODS: We Selected 60 elderly patients ( 60 eyes ) with AMD and SPED in our hospital from February 2015 to February 2016, treated by intravitreal injection of ranibizumab. The best corrected visual acuity ( BCVA ) , PED height and volume, central fovea thickness ( CFT ) and aqueous humor vascular endothelial growth factor ( VEGF) were measured before and after treatment. ·RESULTS:The BCVA of patients with after treatment for 1, 3 and 6mo were 0. 6 ± 0. 1, 0. 4 ± 0. 1 and 0. 3 ± 0. 1, and were significantly higher than those before treatment ( P<0. 05). At 1, 3 and 6mo after treatment PED height and volume were significantly lower than before treatment (P<0. 05), of which 6mo after the treatment PED height and volume were 240. 02 ± 35. 10μm and 0. 310 ± 0. 120mm3 . At 6mo after treatment CFT was 290. 02±33. 10μm, significantly lower than before and 1mo after treatment (P<0. 05). At 1, 3 and 6mo after treatment VEGF were lower than those before treatment (P<0. 05), in which 6mo after the treatment aqueous humor VEGF was 149. 11 ± 28. 89pg/mL. No endophthalmitis, uveitis and so on adverse reactions were observed during treatment. ·CONCLUSION:IVR has a good effect in the treatment of exudative AMD in elderly patients with serous PED, which can effectively improve the visual acuity of patients, reduce the height and volume of PED and the concentration of VEGF in aqueous humor, and it is safe and reliable.
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Purpose: The study aimed to investigate the quantitative changes of retinal pigment epithelial (RPE) atrophy during a 24‑month follow‑up period of anti‑vascular endothelial growth factor (VEGF) for exudative age‑related macular degeneration (AMD). Materials and Methods: This is a retrospective study. Sixty‑five eyes of 62 consecutive patients with naïve exudative AMD who had received treatment with anti‑VEGF therapy and followed for more 24 months were enrolled. All patients received three initial monthly injections of anti‑VEGF (ranibizumab or bevacizumab), followed by pro re nata or treat‑and‑extend protocol. Color fundus image, optical coherence tomography, and fundus autofluorescence were evaluated for RPE atrophy. Multiple regression analysis was performed to investigate the predictive factors found during univariate analysis to identify an association with increased RPE atrophic areas. Results: The mean number of anti‑VEGF treatments was 9.18. RPE atrophic area was 1.293 ± 1.298 mm2 at baseline and enlarged to 2.394 ± 1.940 mm2 after 24 months, which differed significantly (P = 0.001). Multiple regression analysis revealed that larger areas of RPE atrophy at month 4 and larger numbers of anti‑VEGF treatments were associated with increased RPE atrophic areas. Conclusions: RPE atrophy progresses in eyes with exudative AMD during anti‑VEGF treatment. Larger areas of RPE atrophy at month 4 and larger numbers of anti‑VEGF injections were associated with an increased risk of progression of RPE atrophy the following treatment. These findings may be useful to clinicians using intravitreal anti‑VEGF for the treatment of exudative AMD, both for selecting an appropriate treatment plan and for predicting the progression of RPE atrophy.
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PURPOSE: To evaluate the long-term outcomes of intravitreal anti-vascular endothelial growth factor (VEGF) monotherapy for patients diagnosed with submacular hemorrhage secondary to exudative age-related macular degeneration. METHODS: This retrospective, observational study included 49 patients (49 eyes) who initially presented with submacular hemorrhage associated with exudative age-related macular degeneration and who were followed-up for at least 24 months. Only eyes that were treated with intravitreal anti-VEGF monotherapy were included in the study. Best-corrected visual acuity (BCVA) measurements obtained at diagnosis, six months, and the final visit were compared. The associations of BCVA at the final visit with baseline BCVA, BCVA at six months, symptom duration, hemorrhage extent, and central foveal thickness were also analyzed. RESULTS: Over the course of follow-up (mean, 32.1 +/- 8.5 months), an average of 5.1 +/- 2.2 anti-VEGF injections were administered. Recurrent hemorrhage was noted in 13 eyes (26.5%). The mean logarithm of the minimal angle of resolution BCVA at diagnosis, six months, and the final visit were 1.40 +/- 0.52, 0.87 +/- 0.64, and 1.03 +/- 0.83, respectively. Both baseline BCVA (p = 0.012) and BCVA at six months (p < 0.001) were significantly associated with BCVA at the final visit. CONCLUSIONS: Improved visual acuity was maintained for more than two years with intravitreal anti-VEGF monotherapy. BCVA at six months is a useful clinical index to predict long-term visual prognosis.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Angiogenesis Inhibitors/administration & dosage , Bevacizumab/administration & dosage , Fluorescein Angiography , Follow-Up Studies , Fundus Oculi , Intravitreal Injections , Ranibizumab/administration & dosage , Retina/diagnostic imaging , Retinal Hemorrhage/diagnosis , Retrospective Studies , Time Factors , Tomography, Optical Coherence , Treatment Outcome , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Visual Acuity , Wet Macular Degeneration/complicationsABSTRACT
PURPOSE: We evaluated the progression of geographic atrophy (GA) based on fundus autofluorescence (FAF) pattern and atrophy size using the fundus camera in non-exudative age-related macular degeneration (ARMD). METHODS: We acquired FAF images in non-exudative ARMD patients over a 2-year period. According to The Fundus Autofluorescence in Age-related Macular Degeneration (FAM) study, FAF patterns of geographic atrophy were classified into 5 categories. Examiners quantified the areas of GA in FAF images and analyzed the progression of atrophy based on FAF pattern and atrophy size. RESULTS: In 86 non-exudative ARMD eyes, elderly patients had faster progression rate of GA. The growth rates of GA were 1.51 mm2/year in 'Diffuse', 1.49 mm2/year in 'Banded', 1.05 mm2/year in 'Patchy', 0.59 mm2/year in 'Focal' and 0.16 mm2/year in 'None' pattern groups. In addition, the growth rate was 0.38 mm2/year in which initial the GA area was smaller than 1 disc area. This was the slowest progression rate among all categories according to initial GA area. CONCLUSIONS: As a result of evaluating the progression of geographic atrophy using FAF over a 2-year period, the growth rate of GA was the fastest in the 'Diffuse' pattern group. Additionally, as the initial GA area became smaller, the progression of GA atrophy was slower (p < 0.002). Although limitations such as short follow-up period and measurement error of GA atrophy area using fundus photography were compensated, the results in the present study were similar to the outcomes of studies on progression of GA based on FAF pattern using the scanning laser ophthalmoscope over several years and the fundus camera for 1 year. In conclusion, the fundus camera is a useful tool for the prediction of long-term progression of GA in patients with non-exudative ARMD.
Subject(s)
Aged , Humans , Atrophy , Follow-Up Studies , Geographic Atrophy , Macular Degeneration , Ophthalmoscopes , PhotographyABSTRACT
In this study, the risk factors that may influence visual improvement after intravitreal ranibizumab (IVR) treatment for exudative age-related macular degeneration (AMD) were examined. From 2008 to 2012, 420 patients (448 eyes) with exudative AMD were prospectively registered at Seoul National University Hospital. From this group of patients, 125 eyes were included in this study. All patients were treated with 3 consecutive IVR injections. The visual acuity (VA) was evaluated at baseline and 1 month after the third ranibizumab injection. To evaluate the risk factors associated with VA improvement after IVR, patient demographic data and systemic risk factors were analyzed. Patients were divided into a poor VA improvement group and a good VA improvement group, with reference to the median visual improvement in all eyes. Among 125 eyes, 66 eyes (52.8%) were included in the responder group and 59 eyes (47.2%) in the non-responder group. The median VA improvement after 3 monthly ranibizumab injections was -0.05 logMAR. Multivariate analyses revealed that current smoking (adjusted OR, 7.540; 95% CI, 1.732-32.823) was independently associated with poor VA improvement after IVR treatment for exudative AMD. In conclusion, cigarette smoking is an independent risk factor for lower VA gains with IVR treatment for exudative AMD.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Antibodies, Monoclonal, Humanized/therapeutic use , Intravitreal Injections , Macular Degeneration/drug therapy , Multivariate Analysis , Odds Ratio , Prospective Studies , Risk Factors , Smoking , Tomography, Optical Coherence , Visual Acuity/physiologyABSTRACT
PURPOSE: To investigate the development of new choroidal neovascularization in fellow eyes of patients treated for unilateral exudative age-related macular degeneration (AMD). METHODS: Three hundred fourteen patients who were first diagnosed with unilateral exudative AMD and treated with intravitreal bevacizumab or ranibizumab were studied retrospectively. RESULTS: New exudative AMD developed in 7.0% of fellow eyes after 1 year, 10.8% after 2 years and 13.7% after more than 2 years. According to the subtype of exudative AMD, there were no significant differences between classic CNV, occult or minimally classic CNV, and PCV in the incidence of new exudative AMD. After 2 years, a higher conversion rate was found in the bevacizumab-treated group than the ranibizumab-treated group. CONCLUSIONS: The cumulative incidence of involvement in fellow eyes with exudative AMD was 13.7% over 2 years.
Subject(s)
Humans , Antibodies, Monoclonal, Humanized , Choroid , Choroidal Neovascularization , Eye , Incidence , Macular Degeneration , Bevacizumab , RanibizumabABSTRACT
AIM:To document the prognosis of laser treatment in patients with exudative age-related macular degeneration (AMD).METHODS:Efficacy of the intervention was evaluated using a before-after method.RESULTS:A total of 392 eyes of 341 patients with exudative AMD were examined.77.6% had choroideal neovascularisation (CNV).Before the use of indocyanine green (ICG) angiography,occult CNV was detected in only 1.8% of the eyes,but after the use of ICG angiography,this increased to 19.5% (P<0.001).Of the 349 eyes which were followed up,visual acuity had remained stable in 68.2% of the eyes.There was a statistically significant relationship between localization of lesion and visual acuity changes on pre-and post-laser treatment (P<0.001).Also there was a statistically significant relationship between localization of lesion and recurrence (P<0.05).The recurrence was less in subfoveal lesions than that in juxtafoveal and extrafoveal lesions.CONCLUSION:ICG angiography is highly important in the treatment of occult CNV.
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AIM: To report the demographic characteristics of a sample of population affected by exudative age-related macular degeneration (AMD) in the region of Castilla-Leon (North-Central Spain), and to compare them with a group of population of the same age and from the same geographic area.METHODS: In this observational, prospective study, AMD patients attending a regional reference clinic for photodynamic therapy were interviewed. The patients reported their medical history for high blood pressure, hyperlipemia and smoking habit. Iris color was examined and classified as fight (green, blue and grey) or dark (hazel, brown, black).RESULTS: A total of 343 patients were interviewed. Mean age at onset was 74.9 years (range 55 to 93), Among whom 64.5% were female and 35.5% male. Iris color was rated as light in 45.1% of the patients. Arterial hypertension (AH) was present in 50% of the cases and 15.3% were on treatment for hypercholesterolemia, and 30.2% of the patients were smokers or had quit smoking (80.9% of males).CONCLUSION: The frequency of light colored iris is higher among patients with exudative AMD. In our series, other risk factors for exudative AMD were smoking habit in males, not being on treatment for hypercholesterolemia and being female.