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1. Expert Panel Consensus for Optimizing Outcomes in Neovascular Age-Related Macular Degeneration in the Context of Suboptimal Response to a Biosimilar: The Role of Aflibercept

Author

Narendran N, Bailey C, Downey L, Gale R, Kotagiri A, Pearce I, Rennie CA, Sivaprasad S, Talks J, Morgan-Warren P, Napier J, O’Neil C, and Seeborne T

Subjects
anti-vegf agents, capacity, consensus pathway, ranibizumab, Ophthalmology, RE1-994
Abstract

Nirodhini Narendran,1,2 Clare Bailey,3 Louise Downey,4 Richard Gale,5 Ajay Kotagiri,6 Ian Pearce,7 Christina A Rennie,8 Sobha Sivaprasad,9 James Talks,10 Peter Morgan-Warren,11 Jackie Napier,11 Carolyn O’Neil,11 Timothy Seeborne11 1The Royal Wolverhampton NHS Trust, Wolverhampton, UK; 2School of Life & Health Sciences, Aston University, Birmingham, UK; 3University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; 4Hull University Teaching Hospitals NHS Trust, Hull, UK; 5York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK; 6South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK; 7Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK; 8University Hospital Southampton NHS Foundation Trust, Southampton, UK; 9NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK; 10Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK; 11Bayer plc, Reading, UKCorrespondence: Nirodhini Narendran, Ophthalmology Department, New Cross Hospital (Part of the Royal Wolverhampton NHS Trust), Wolverhampton Road, Wolverhampton, WV10 0QP, UK, Email niro.narendran@nhs.netPurpose: The inclusion of ranibizumab biosimilars into National Health Service England commissioning recommendations published in 2022 created a need for expert guidance to optimize treatment outcomes in patients with neovascular age-related macular degeneration (nAMD) who otherwise may not have received first-line ranibizumab. This article provides a consensus treatment pathway supporting timely identification and management of a suboptimal response to these therapies, thereby aiming to facilitate clinically meaningful outcomes and efficient management of service capacity under specific circumstances where ranibizumab biosimilars may be initiated as a first-line treatment.Methods: Two structured round-table meetings of UK medical retina specialists were held in person and virtually on September 22 and November 3, 2022, respectively. These meetings were organized and funded by Bayer.Results: The panel provided guidance on the implementation of an early treatment optimization pathway in cases where ranibizumab biosimilars are used as a first-line treatment, including recommendations on patient suitability and capacity requirements, and criteria for identification and strategies for management of a suboptimal response. The panel discussed the role of aflibercept treatment and its potential benefits and outlined recommendations on switching ranibizumab biosimilar suboptimal responders to an aflibercept treat-and-extend regimen, where appropriate.Conclusion: Developed by a retinal expert panel, this early treatment optimization pathway provides guidance to facilitate optimal long-term patient outcomes while addressing capacity and resourcing constraints in circumstances of first-line ranibizumab biosimilar use for nAMD, including how aflibercept may be used in cases with a suboptimal response. Therefore, this fills an important gap in guidance on navigating the new treatment landscape.Keywords: anti-VEGF agents, capacity, consensus pathway, ranibizumab

Published
2024

2. Performing Sensitive Clinical Examinations During Urological Telemedicine Visits: How to Avoid Pitfalls?

Author

Desai C, Pearce I, and Modgil V

Subjects
telemedicine, sensitive examination, remote examination, urology, covid-19, Diseases of the genitourinary system. Urology, RC870-923
Abstract

Chaitya Desai,1 Ian Pearce,2 Vaibhav Modgil2 1University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; 2Manchester Andrology Centre, Manchester University NHS Foundation Trust, Manchester, UKCorrespondence: Chaitya DesaiUniversity Hospitals Birmingham NHS Foundation Trust, Birmingham, UKTel +44 7493 063410Email chaitya.desai@nhs.netBackground and Aims: The impact of coronavirus disease 2019 presented an unprecedented challenge to urological service globally. In many countries, outpatient clinics were cancelled, and the use of telemedicine visits was increased. For urological complaints, the need to perform a sensitive clinical examination via telemedicine posed an unfamiliar environment. Our aim is to explore the clinical and ethical factors involved in performing remote sensitive clinical examinations.Methods: A comprehensive review of literature and guidance from various medical bodies internationally was conducted using suitable keywords on the search engines of PubMed, SCOPUS, Google Scholar, and Research Gate in the first week of March 2021 including “COVID-19,” “telemedicine,” “urology,” and “sensitive examinations.&#x201DResults: Telemedicine reduced unnecessary visits to medical facilities and was useful for reducing the risk of transmission during the COVID-19 pandemic. We propose that in order to perform a sensitive clinical examination via telemedicine, the following four steps must be considered: assessment of the clinical need, obtaining informed consent, use of a chaperone, and thorough documentation.Conclusion: Telemedicine will play a pivotal role in the future of urological practice beyond this present pandemic. However, sensitive clinical examinations using such technology must be performed in appropriate settings and situations. Suitable training, enhanced documentation, communication, and observing information governance guidance will aid in avoiding clinical and ethical pitfalls.Keywords: telemedicine, sensitive examination, remote examination, urology, COVID-19

Published
2021

3. Providing a Safe and Effective Intravitreal Treatment Service: Strategies for Service Delivery

Author

Amoaku W, Bailey C, Downey L, Gale RP, Ghanchi F, Hamilton R, Mahmood S, Menon G, Nosek J, Pearce I, and Yang Y

Subjects
capacity, intravitreal service, namd, resources, Ophthalmology, RE1-994
Abstract

Winfried Amoaku,1 Clare Bailey,2 Louise Downey,3 Richard P Gale,4 Faruque Ghanchi,5 Robin Hamilton,6 Sajjad Mahmood,7 Geeta Menon,8 Jenny Nosek,9 Ian Pearce,10 Yit Yang11 1Academic Ophthalmology, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK; 2University Hospitals Bristol NHS Foundation Trust, Bristol, UK; 3Hull and East Yorkshire Eye Hospital, Hull University Teaching Hospital, Hull, UK; 4York Teaching Hospital NHS Foundation Trust, York, UK; 5Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK; 6Moorfield Eye Hospital NHS Foundation Trust, London, UK; 7Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; 8Frimley Health NHS Foundation Trust, Frimley, UK; 9Royal Shrewsbury Hospital, Shropshire, UK; 10St Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool, UK; 11Wolverhampton Eye Infirmary, The Royal Wolverhampton NHS Trust, Wolverhampton, UKCorrespondence: Louise Downey Email Louise.Downey@hey.nhs.ukAbstract: An aging population leads to increasing demand for medical retina services with chronic diseases being managed in long-term care pathways. Many hospital services struggle to deliver efficient and effective MR care due, at least in part, to infrastructure that does not expand responsively enough to meet the increased demand. A steering committee of retinal specialists from a variety of UK NHS hospital ophthalmology departments with experience of leading and managing NHS retinal services in the intravitreal era came together for the generation of this document to review and compile key aspects that should be considered when optimising intravitreal treatment capacity within MR services. This article aims to provide a useful collation and signposting of key published evidence, consensus and insights on aspects of delivering an intravitreal service, including treatment regimens, virtual clinics, staff training and governance, telemedicine and information technology, and data collection and key performance indicators. The objective is to equip ophthalmologic healthcare professionals with the necessary tools to develop and adapt their local service in the face of current and projected increased demand.Keywords: capacity, intravitreal service, nAMD, resources

Published
2020

5. (507) Predictors of Postoperative IPP Length: A Multicenter, Multinational Analysis

Author

Barham, D, primary, Huynh, L, additional, Hammad, M, additional, Swerdloff, D, additional, Andrianne, R, additional, Gross, M, additional, Hatzichristodoulou, G, additional, Hotaling, J, additional, Hsieh, T, additional, Jenkins, L, additional, Lentz, A, additional, Osmonov, D, additional, Park, S H, additional, Pearce, I, additional, Perito, P, additional, Sadeghi-Nejad, H, additional, Simhan, J, additional, Warner, J N, additional, Ziegelmann, M, additional, and Yafi, F, additional

Published
2023
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7. (105) A Multicenter Analysis of the AUA Recommended Antibiotic Prophylaxis for Penile Implantation Results in Higher, not Lower, Infection Risk

Author

Barham, D, primary, Hammad, M, additional, Pyrgidis, N, additional, Swerdloff, D, additional, Van Renterghem, K, additional, Alwaal, A, additional, Ziegelmann, M, additional, Gross, M, additional, Simhan, J, additional, Hatzichristodoulou, G, additional, Hotaling, J, additional, Hsieh, T, additional, Warner, N, additional, Lentz, A, additional, Sadeghi-Nejad, H, additional, Osmonov, D, additional, Park, S H, additional, Pearce, I, additional, Perito, P, additional, and Yafi, F, additional

Published
2023
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8. (104) A Multicenter Evaluation of Penile Curvature Correction in Men with Peyronie’s Disease Undergoing Inflatable Penile Prosthesis Placement

Author

Hammad, M A M, primary, Barham, D W, additional, Nguyen, T, additional, Jenkins, L, additional, Swerdloff, D, additional, Gross, K, additional, Hatzichristodoulou, G, additional, Jones, J, additional, Hotaling, J, additional, Pearce, I, additional, Sadeghi-Nejad, H, additional, Simhan, J, additional, Yafi, F, additional, and Gross, M, additional

Published
2023
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10. Creep rupture and creep life prediction of aluminium airframe alloys

Author

Pearce, I.

Subjects
669
Abstract

Aluminium alloys 2419-T851, 2124-T851 and 7010-T7351 are candidates to succeed the current airframe alloy, RR58. In the present work, high precision constant stress creep curves have been obtained for alloys 2419-T851 and 7010-T7351 over an approximate stress range 100-400MPa at 373-463K. In the case of alloy 2419-T851, the creep curves recorded were predominantly primary in nature, alloy 7010-T7351 exhibited predominantly tertiary curves, while creep curves reported (2) for 2124-T851 showed an intermediate curve shape. These results have been analysed to allow comparisons to be made between conventional methods of creep data representation and a new approach, termed the theta Projection Concept.

Published
1991

11. A Prospective Multicentre Audit Evaluating the Incidence of Iatrogenic Urethral Catheterisation Injuries

Author

Hayes, L., primary, Croghan, S.M., additional, Riogh, A. Nic an, additional, Madden, A., additional, Considine, S.W., additional, Rochester, M., additional, Finch, W., additional, Carrie, A., additional, Mahhmalji, W., additional, Elhadi, W., additional, Thursby, H., additional, Pearce, I., additional, Modgil, V., additional, Noweir, H., additional, Cunnane, C.V., additional, Giri, S.K., additional, Davis, N.F., additional, Mulvihill, J., additional, Walsh, M.T., additional, and Flood, H.D., additional

Published
2022
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12. Nomogram predicting the probability of spontaneous stone passage in patients presenting with acute ureteric colic

Author

Gao, C, Peters, M, Kurver, P, Anbarasan, T, Jayaraajan, K, Manning, T, Cashman, S, Nambiar, A, Cumberbatch, M, Lamb, BW, Pickard, R, Erotocritou, P, Smith, D, Kasivisvanathan, V, Shah, TT, Abboudi, H, Abdelmoteleb, H, Abu Yousif, M, Acher, P, Adams, R, Ager, M, Ahmed, I, Ajayi, L, Akintimehin, A, Akman, J, Al Hayek, S, Al‐Dhahir, W, Al‐Qassim, Z, Al‐Shakhshir, S, Alberto, M, Ali Abdaal, C, Arya, M, Assaf, N, Ayres, B, Badgery, H, Bateman, K, Bdesha, A, Bedi, N, Begum, R, Belal, M, Biyani, CS, Bolton, D, Bultitude, M, Burge, F, Bycroft, J, Cameron, F, Campbell, A, Cannon, A, Carrie, A, Chappell, B, Chin, AOL, Chow, K, Christidis, D, Clements, J, Coode‐Bate, J, Cronbach, P, Curry, D, Dasgupta, R, Demirel, S, Derbyshire, L, Din, W, Docherty, E, Edison, E, Eldred‐Evans, D, Ellis, G, Evans, S, Foley, R, Frymann, R, Gallagher, M, Gowardhan, B, Graham, J, Graham, S, Gray, S, Grice, P, Gupta, S, Hamad, S, Hann, G, Harris, A, Hatem, E, Hawary, A, Hayat, Z, Hayne, D, Hegazy, M, Henderson, J, Hendry, J, Ho, C, Hughes‐Hallet, A, Hussain, A, Hussain, Z, Ibrahim, H, Irving, S, Ivin, N, Jaffer, A, Jalil, R, Kashora, F, Kavia, R, Kerr, L, Khadouri, S, Khan, A, Khan, M, Khan, S, Koschel, S, Kozan, AA, Kum, F, Kynaston, H, Laird, A, Lavan, L, Lawrentschuk, N, Lee, JCM, Lee, S, Liew, M, Mackenzie, K, Malki, M, Manson‐Bahr, D, Mason, H, Matanhelia, M, Maw, J, Mbuvi, J, Mc Cauley, N, Mc Grath, S, Mc Kay, AC, Mcilhenny, C, Miakhil, I, Miller, M, Mirza, AB, Morrison‐Jones, V, Morrow, J, Mosey, R, Murtagh, K, Natarajan, M, Nehikhare, Y, Ness, D, Ng, A, Ngweso, S, Nkwam, N, Nyandoro, M, Nzenza, T, O’ Brien, J, O’ Rourke, J, Olaniyi, P, Olivier, J, Osman, B, Oyekan, A, Pang, K, Pankhania, R, Parwaiz, I, Parys, B, Patterson, J, Pearce, I, Phipps, S, Premakumar, Y, Probert, JL, Quinlan, D, Ratan, H, Reid, K, Rezacova, M, Rezvani, S, Rodger, F, Rogers, A, Ross, D, Rowbotham, C, Rujancich, P, Ruljancich, P, Sadien, I, Sakthivel, A, Saleemi, A, Samsudin, A, Sandhu, S, Seaward, L, Sharma, A, Sharma, S, Shergill, I, Shetty, A, Shingles, C, Simmons, L, Simpson, R, Simson, N, Singh, H, Sriprasad, S, Stammeijer, R, Steen, C, Stewart, H, Stonier, T, Suraparaj, L, Swallow, D, Symes, A, Symes, R, Tailor, K, Tait, C, Tam, JP, Tay, J, Tay, LJ, Tregunna, R, Tudor, E, Udovichich, C, Umez‐Eronini, N, Wang, L, Ward, A, Weeratunga, G, Withington, J, Wong, C, Wozniak, S, Yassaie, O, and Young, M

Abstract

Objectives\ud \ud To develop a nomogram that could predict spontaneous stone passage (SSP) in patients presenting with acute ureteric colic who are suitable for conservative management.\ud \ud \ud \ud Patients and Methods\ud \ud A 2517 patient dataset was utilised from an international multicentre cohort study (MIMIC, A Multi-centre Cohort Study Evaluating the role of Inflammatory Markers In Patients Presenting with Acute Ureteric Colic) of patients presenting with acute ureteric colic across 71 secondary care hospitals in the UK, Ireland, Australia, and New Zealand. Inclusion criteria mandated a non-contrast computed tomography of the kidneys, ureters, and bladder. SSP was defined as the ‘absence of the need for intervention’. The model was developed using logistic regression and backwards selection (to achieve lowest Akaike's information criterion) in a subset from 2009–2015 (n = 1728) and temporally validated on a subset from 2016–2017 (n = 789).\ud \ud \ud \ud Results\ud \ud Of the 2517 patients, 1874 had SSP (74.5%). The mean (SD) age was 47 (14.7) years and 1892 were male (75.2%). At the end of the modelling process, gender: male (odds ratio [OR] 0.8, 95% confidence interval [CI] 0.64–1.01, P = 0.07), neutrophil count (OR 1.03, 95% CI 1.00–1.06, P = 0.08), hydronephrosis (OR 0.79, 95% CI 0.59–1.05, P = 0.1), hydroureter (OR 1.3, 95% CI 0.97–1.75, P = 0.08), stone size >5–7 mm (OR 0.2, 95% CI 0.16–0.25, P 7 mm (OR 0.11, 95% CI 0.08–0.15, P

Published
2022

13. Recommendations for OCT Angiography Reporting in Retinal Vascular Disease: A Delphi Approach by International Experts.

Author

Munk, MR, Kashani, AH, Tadayoni, R, Korobelnik, J-F, Wolf, S, Pichi, F, Koh, A, Ishibazawa, A, Gaudric, A, Loewenstein, A, Lumbroso, B, Ferrara, D, Sarraf, D, Wong, DT, Skondra, D, Rodriguez, FJ, Staurenghi, G, Pearce, I, Kim, JE, Freund, KB, Parodi, MB, Waheed, NK, Rosen, R, Spaide, RF, Nakao, S, Sadda, S, Vujosevic, S, Wong, TY, Murata, T, Chakravarthy, U, Ogura, Y, Huf, W, Tian, M, Munk, MR, Kashani, AH, Tadayoni, R, Korobelnik, J-F, Wolf, S, Pichi, F, Koh, A, Ishibazawa, A, Gaudric, A, Loewenstein, A, Lumbroso, B, Ferrara, D, Sarraf, D, Wong, DT, Skondra, D, Rodriguez, FJ, Staurenghi, G, Pearce, I, Kim, JE, Freund, KB, Parodi, MB, Waheed, NK, Rosen, R, Spaide, RF, Nakao, S, Sadda, S, Vujosevic, S, Wong, TY, Murata, T, Chakravarthy, U, Ogura, Y, Huf, W, and Tian, M

Abstract

PURPOSE: To develop a consensus nomenclature for reporting OCT angiography (OCTA) findings in retinal vascular disease (e.g., diabetic retinopathy, retinal vein occlusion) by international experts. DESIGN: Delphi-based survey. SUBJECTS, PARTICIPANTS, AND/OR CONTROLS: Twenty-five retinal vascular disease and OCTA imaging experts. METHODS, INTERVENTION, OR TESTING: A Delphi method of consensus development was used, comprising 2 rounds of online questionnaires, followed by a face-to-face meeting conducted virtually. Twenty-five experts in retinal vascular disease and retinal OCTA imaging were selected to constitute the OCTA Nomenclature in Delphi Study Group for retinal vascular disease. The 4 main areas of consensus were: definition of the parameters of "wide-field (WF)" OCTA, measurement of decreased vascular flow on conventional and WF-OCTA, nomenclature of OCTA findings, and OCTA in retinal vascular disease management and staging. The study end point was defined by the degree of consensus for each question: "strong consensus" was defined as ≥85% agreement, "consensus" as 80% to 84%, and "near consensus" as 70% to 79%. MAIN OUTCOME MEASURES: Consensus and near consensus on OCTA nomenclature in retinal vascular disease. RESULTS: A consensus was reached that a meaningful change in percentage of flow on WF-OCTA imaging should be an increase or decrease ≥30% of the absolute imaged area of flow signal and that a "large area" of WF-OCTA reduced flow signal should also be defined as ≥30% of the absolute imaged area. The presence of new vessels and intraretinal microvascular abnormalities, the foveal avascular zone parameters, the presence and amount of "no-flow areas," and the assessment of vessel density in various retinal layers should be added for the staging and classification of diabetic retinopathy. Decreased flow ≥30% of the absolute imaged area should define an ischemic central retinal vein occlusion. Several other items did not meet consensus requirements or were

Published
2022

16. Altmetrics and citations: the impact of journal publications

Author

Pearce I, Noah Ao, and Modgil

Subjects
03 medical and health sciences, 0302 clinical medicine, 05 social sciences, Library science, General Medicine, Altmetrics, 0509 other social sciences, 050904 information & library sciences, Psychology, 030217 neurology & neurosurgery, Field (geography)
Abstract

To assess the correlation between the altmetric attention score and citations as measures of impact for scholarly publications within and outside of the urological field, we compared altmetric attention scores and citations in two groups of journal articles, a urological group ( n=13) and a non-urological group ( n=129). All papers were high altmetric score publications. How researchers can benefit from alternative measures to make their mark.

Published
2020

17. Environmental Changes in the North Atlantic Region: SCANNET as a Collaborative Approach for Documenting, Understanding and Predicting Changes

Author

Callaghan, Terry V., Johansson, M., Heal, O. W., Sælthun, N. R., Barkved, L. J., Bayfield, N., Brandt, O., Brooker, R., Christiansen, H. H., Forchhammer, M., Høye, T. T., Humlum, O., Järvinen, A., Jonasson, C., Kohler, J., Magnusson, B., Meltofte, H., Mortensen, L., Neuvonen, S., Pearce, I., Rasch, M., Turner, L., Hasholt, B., Huhta, E., Leskinen, E., Nielsen, N., and Siikamäki, P.

Published
2004

19. Incidence of iatrogenic urethral catheterisation injuries: A prospective multicentre audit

Author

Croghan, S.M., primary, Riogh, A. Nican, additional, Madden, A., additional, Considine, S., additional, Rochester, M., additional, Finch, W., additional, Carrie, A., additional, Mahhmalji, W., additional, Elhadi, W., additional, Thursby, H., additional, Pearce, I., additional, Modgil, V., additional, Noweir, H., additional, Cunnane, C., additional, Giri, S., additional, Davis, N.F., additional, Mulvihill, J., additional, Walsh, M.T., additional, and Flood, H.D., additional

Published
2021
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38. Peel and peel again

Author

Gibran, S.K., Flemming, B., Stappler, T., Pearce, I., Groenewald, C., Heimann, H., Hiscott, P., and Wong, D.

Subjects
Macular degeneration -- Care and treatment, Vitrectomy -- Methods, Vitrectomy -- Patient outcomes, Vitrectomy -- Research, Health
Published
2008

39. Graefes Arch Clin Exp Ophthalmol

Author

Korobelnik, Jean-François, Loewenstein, A., ELDEM, B., JOUSSEN, A. M., Koh, A., LAMBROU, G. N., Lanzetta, P., Li, Xiaojian, LOVESTAM-ADRIAN, M., Navarro, R., OKADA, A. A., Pearce, I., RODRIGUEZ, F. J., WONG, D. T., Wu, L., Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), and CHU Bordeaux [Bordeaux]

Subjects
Coronavirus, Ophthalmology, Vision Academy, Retinal disease, COVID-19, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Recommendations, [SDV.MHEP.OS]Life Sciences [q-bio]/Human health and pathology/Sensory Organs
Abstract

International audience; Purpose: There is an urgent need to address how to best provide ophthalmic care for patients with retinal disease receiving intravitreal injections with anti-vascular endothelial growth factor agents during the ongoing global COVID-19 pandemic. This article provides guidance for ophthalmologists on how to deliver the best possible care for patients while minimizing the risk of infection.Methods: The Vision Academy’s Steering Committee of international retinal disease experts convened to discuss key considerations for managing patients with retinal disease during the COVID-19 pandemic. After reviewing the existing literature on the issue, members put forward recommendations that were systematically refined and voted on to develop this guidance.Results: The considerations focus on the implementation of steps to minimize the exposure of patients and healthcare staff to COVID-19. These include the use of personal protective equipment, adherence to scrupulous hygiene and disinfection protocols, pre-screening to identify symptomatic patients, and reducing the number of people in waiting rooms. Other important measures include triaging of patients to identify those at the greatest risk of irreversible vision loss and prioritization of treatment visits over monitoring visits where possible. In order to limit patient exposure, ophthalmologists should refrain from using treatment regimens that require frequent monitoring.Conclusion: Management of patients with retinal disease receiving intravitreal injections during the COVID-19 pandemic will require adjustment to regular clinical practice to minimize the risk of exposure of patients and healthcare staff, and to prioritize those with the greatest medical need. The safety of patients and healthcare staff should be of paramount importance in all decision-making.

Published
2020

40. Pachychoroid: current concepts on clinical features and pathogenesis

Author

Castro-Navarro V, Behar-Cohen F, Chang W, Joussen A, Lai T, Navarro R, Pearce I, Yanagi Y, and Okada A

Subjects
Pachychoroid neovasculopathy, Peripapillary pachychoroid syndrome, Pachydrusen, sense organs, Pachychoroid, Pachychoroid pigment epitheliopathy, Focal choroidal excavation
Abstract

Purpose The term "pachychoroid" refers to a newly described phenotype in which functional and structural choroidal changes are thought to play a key pathogenic role in a spectrum of related retinal disorders. A more detailed understanding of how the choroid is involved within this spectrum and a better knowledge of the most relevant clinical signs of the pachychoroid phenotype are important to differentiate these disorders from other retinal conditions. Our objectives are to provide a literature review of pachychoroid and the commonalities that may be present across pathologies included in the spectrum, and to provide details on the examination, monitoring, and management of these disorders. Methods We searched the PubMed web platform to identify relevant studies using the following keywords: pachychoroid, pachychoroid pigment epitheliopathy, pachychoroid neovasculopathy, aneurysmal type 1 neovascularization, focal choroidal excavation, peripapillary pachychoroid syndrome, vasculopathy pachysclera, pachychoroid geographic atrophy, and pachydrusen. We selected 157 publications and identified the most important features related to pachychoroid. Results The presence of hypertrophic or congested vessels in the choroid, not thickened choroid per se, under an area of reduced or absent choriocapillaris in the posterior pole seems to be the most salient feature of pachychoroid. However, other qualitative/quantitative features are needed to differentiate the uncomplicated pachychoroid from the pathological pachychoroid clinical spectrum, which may be associated with exudation, neovascularization, and/or retinal pigment epithelium and photoreceptor atrophy. Conclusions The most salient feature of pachychoroid appears to be the presence of large vessels under an area of reduced or absent choriocapillaris. Knowledge of the features and pathogenesis of the different disorders in the pachychoroid spectrum may assist in the management of patients.

Published
2020

41. Real-world outcomes with ranibizumab in branch retinal vein occlusion: The prospective, global, LUMINOUS study

Author

Pearce, I., Clemens, A., Brent, M. H., Lu, L., Gallego-Pinazo, R., Minnella, Angelo Maria, Creuzot-Garcher, C., Spital, G., Sakamoto, T., Dunger-Baldauf, C., Mcallister, I. L., Banerjee, S., Venkatraman, L., Minnella A. M. (ORCID:0000-0001-5896-5313), Pearce, I., Clemens, A., Brent, M. H., Lu, L., Gallego-Pinazo, R., Minnella, Angelo Maria, Creuzot-Garcher, C., Spital, G., Sakamoto, T., Dunger-Baldauf, C., Mcallister, I. L., Banerjee, S., Venkatraman, L., and Minnella A. M. (ORCID:0000-0001-5896-5313)

Abstract

Objective To evaluate the effectiveness, safety, and treatment patterns of ranibizumab 0.5 mg in treatment-naïve patients with branch retinal vein occlusion (BRVO) enrolled in the LUMINOUSTM study. Study design A 5-year, global, prospective, multicenter, observational, open-label study conducted in a clinical practice (real-world) setting at outpatient ophthalmology clinics that recruited 30,138 consenting adult patients from all approved indications for ranibizumab across 42 countries. Patients with BRVO were treated according to the local ranibizumab label of the participating countries. Mean change in visual acuity (VA) in Early Treatment Diabetic Retinopathy Study letters from baseline to Year 1, treatment exposure during Year 1, and adverse events (AEs) over 5 years were assessed. Results Of the 1366 recruited BRVO patients, 405 were treatment-naïve at baseline with a mean (standard deviation [SD]) age of 67.9 (12.5) years, 57.5% were female, and 71.8% were White. At Year 1 (n = 189), the mean (SD) VA gain was 11.9 (17.66) letters from a baseline of 49.2 (±20.32) letters with a mean (SD) of 5.0 (2.34) injections. VA gains were higher in patients (n = 83) who received 6-9 injections (13.6 [20.16] letters) than in those who received 2-5 injections (n = 92, 11.7 [15.43] letters), or 1 injection (n = 14, 3.6 [13.72] letters). Patients with baseline VA <23 letters had numerically highest VA gains (n = 20, 31.1 [24.48] letters). Over 5 years, the rate of ocular/non-ocular AEs was 7.4%/9.1% and serious AEs was 0.3%/4.4% in treatment-naïve BRVO patients (n = 405). Conclusions One year results from the LUMINOUS real-world study showed a clinically meaningful VA improvement with ranibizumab in treatment-naïve patients with BRVO; numerically higher VA gains were achieved in patients who received more injections and those with poor baseline VA. No new safety signals were observed.

Published
2020

49. A noninterventional study to monitor patients with diabetic macular oedema starting treatment with ranibizumab (POLARIS)

Author

Stefanickova J., Cunha-Vaz J., Ulbig M., Pearce I., Fernandez-Vega Sanz A., Theodossiadis P., Kodjikian L., Izmailov A., Muston D., Vassilev Z., Lamotte B., Tuckmantel C., Friedl S., Altemark A., Schwarz H. -J., Katz T., Souied E., Lalloum F., Querques G., Ayello-Scheer S., Coriat C., Girens J. F., Sahel J. -A., Creuzot-Garcher C., Bremond-Gignac D., Chiambaretta F., Farguette F., Delhay C., Baillif-Gostoli S., Maschi C., Fajnkuchen F., Milazzo S., Benzerroug M., Theron J. P., Schmickler S., Zywien A., Bopp S., Hoh H., Campean P., Schattmann K., Fromberg I., Fromberg C., Fromberg D., Spital G., Heimes B., Emmerich K. -H., Lang M., Krieb A., Xafis G., Stock L., Klotz N., Ungerechts R., Matuschek A., Radermacher M., Thelen U., Tetz M., Denisiuk M., Berens U., Schumacher A., Neuhann T., Lange O., Richard G., Wieland M., Filev F., Bittersohl D., Wiedemann P., Lorenz K., Wasielica-Poslednik J., Rosbach J., Dave H., Wirtz N., Weber B., Gelisken F., Wilhelm B., Peters T., Konig T., Kampik A., Abbasova S., Wolf A., Kurz S., Herold T., Arend N., Dabov S., Prause K., Fazekas C., Martz J., Bayerl K., Heuer U., Bischoff G., Kunne C., Lorenz B., Jager M., Schiel H., Datseris I., Diamanti-Ramza A., Charonis A., Straga I., Babouli N., Brevetti C., Tranos P., Perganta G., Panayiotis T., Angeliki A., Dinioti T., Tsironi E., Kotoula M., Brazitikos P., Nanas D., Figueira J., Ribeiro L., Molodkina N., Abdulaeva E., Pashtaev N., Ovchinnikova V., Yurieva T., Vaycheslav B., Liya R., Ahlers J., Zmatlova I., Popovcova M., Bajacek J., Panisova J., Struharova K., Sturova L., Jamrichova Z., Krasnik V., Krajcova P., Hasa J., Piovarciova E., Gajdosova M., Vida R., Janco L., Leskova V., Demsky P., Alexik M., Falatova A., Lipkova B., Stubna M., Tomaskova D., Herle D., Martinez Alday N., Sanchez Aparicio J. A., Martinez Anton M., Lopez Galvez M. I., Manzanas Leal L., Juberias Sanchez R., Perez Belmonte L., Fernandez-Vega Sanz B., Villota Deleu E., Gloria D. L. T. C., Canga S., De Santiago Rodiguez M. A., Ramos Gonzalez D., Prieto Maratin J. F., Franco Suarez-Barcena I., Casado Prieto A., Hernandez Galilea E., Gomez Ledesma I., de Juan Marco L., Mendivil Soto M. P., Bearan I., Nunez M., Lopez Garrido J. L., Rodriguez Raton A., Cincunegui J., Vazquez Cruchaga E., Quiroga de la Hera P., Fernandez Rodriguez M., Rodriguez Cid M. J., Mendez Martinez S., Gonzalez Martinez A., Gomez-Ulla F., Garcia Garces I., Martinez Perez L., Mansilla Cunarro R., Abraldes Lopez-Veiga M., Rodriguez Nunez M., Pineiro Figuera M. C., Rodriguez Ferro F., Menon G., North L., Chandran M., Retnamma R., Sivaprasad S., Taylor S., Scanlon P., Johnston R., Chong V., Mall S., Bailey C., Varma D., Talks J., Lotery A., Thulasidharan S., Eckstein M., Fahd Q., Koshy Z., Hanumanthu S., Kelly S., Evangelos S., Ghanchi F., Asaria R., Harris M., Derdeb T., Dipa G., Mahuma I., Stefanickova, J., Cunha-Vaz, J., Ulbig, M., Pearce, I., Fernandez-Vega Sanz, A., Theodossiadis, P., Kodjikian, L., Izmailov, A., Muston, D., Vassilev, Z., Lamotte, B., Tuckmantel, C., Friedl, S., Altemark, A., Schwarz, H. -J., Katz, T., Souied, E., Lalloum, F., Querques, G., Ayello-Scheer, S., Coriat, C., Girens, J. F., Sahel, J. -A., Creuzot-Garcher, C., Bremond-Gignac, D., Chiambaretta, F., Farguette, F., Delhay, C., Baillif-Gostoli, S., Maschi, C., Fajnkuchen, F., Milazzo, S., Benzerroug, M., Theron, J. P., Schmickler, S., Zywien, A., Bopp, S., Hoh, H., Campean, P., Schattmann, K., Fromberg, I., Fromberg, C., Fromberg, D., Spital, G., Heimes, B., Emmerich, K. -H., Lang, M., Krieb, A., Xafis, G., Stock, L., Klotz, N., Ungerechts, R., Matuschek, A., Radermacher, M., Thelen, U., Tetz, M., Denisiuk, M., Berens, U., Schumacher, A., Neuhann, T., Lange, O., Richard, G., Wieland, M., Filev, F., Bittersohl, D., Wiedemann, P., Lorenz, K., Wasielica-Poslednik, J., Rosbach, J., Dave, H., Wirtz, N., Weber, B., Gelisken, F., Wilhelm, B., Peters, T., Konig, T., Kampik, A., Abbasova, S., Wolf, A., Kurz, S., Herold, T., Arend, N., Dabov, S., Prause, K., Fazekas, C., Martz, J., Bayerl, K., Heuer, U., Bischoff, G., Kunne, C., Lorenz, B., Jager, M., Schiel, H., Datseris, I., Diamanti-Ramza, A., Charonis, A., Straga, I., Babouli, N., Brevetti, C., Tranos, P., Perganta, G., Panayiotis, T., Angeliki, A., Dinioti, T., Tsironi, E., Kotoula, M., Brazitikos, P., Nanas, D., Figueira, J., Ribeiro, L., Molodkina, N., Abdulaeva, E., Pashtaev, N., Ovchinnikova, V., Yurieva, T., Vaycheslav, B., Liya, R., Ahlers, J., Zmatlova, I., Popovcova, M., Bajacek, J., Panisova, J., Struharova, K., Sturova, L., Jamrichova, Z., Krasnik, V., Krajcova, P., Hasa, J., Piovarciova, E., Gajdosova, M., Vida, R., Janco, L., Leskova, V., Demsky, P., Alexik, M., Falatova, A., Lipkova, B., Stubna, M., Tomaskova, D., Herle, D., Martinez Alday, N., Sanchez Aparicio, J. A., Martinez Anton, M., Lopez Galvez, M. I., Manzanas Leal, L., Juberias Sanchez, R., Perez Belmonte, L., Fernandez-Vega Sanz, B., Villota Deleu, E., Gloria, D. L. T. C., Canga, S., De Santiago Rodiguez, M. A., Ramos Gonzalez, D., Prieto Maratin, J. F., Franco Suarez-Barcena, I., Casado Prieto, A., Hernandez Galilea, E., Gomez Ledesma, I., de Juan Marco, L., Mendivil Soto, M. P., Bearan, I., Nunez, M., Lopez Garrido, J. L., Rodriguez Raton, A., Cincunegui, J., Vazquez Cruchaga, E., Quiroga de la Hera, P., Fernandez Rodriguez, M., Rodriguez Cid, M. J., Mendez Martinez, S., Gonzalez Martinez, A., Gomez-Ulla, F., Garcia Garces, I., Martinez Perez, L., Mansilla Cunarro, R., Abraldes Lopez-Veiga, M., Rodriguez Nunez, M., Pineiro Figuera, M. C., Rodriguez Ferro, F., Menon, G., North, L., Chandran, M., Retnamma, R., Sivaprasad, S., Taylor, S., Scanlon, P., Johnston, R., Chong, V., Mall, S., Bailey, C., Varma, D., Talks, J., Lotery, A., Thulasidharan, S., Eckstein, M., Fahd, Q., Koshy, Z., Hanumanthu, S., Kelly, S., Evangelos, S., Ghanchi, F., Asaria, R., Harris, M., Derdeb, T., Dipa, G., and Mahuma, I.

Subjects
Male, Vascular Endothelial Growth Factor A, Time Factors, Visual acuity, genetic structures, Visual Acuity, Angiogenesis Inhibitors, anti‐VEGF, 0302 clinical medicine, Primary outcome, Retrospective Studie, Medicine, Macula Lutea, 030212 general & internal medicine, Fluorescein Angiography, Anti vegf, General Medicine, Middle Aged, ddc, Europe, anti-VEGF, diabetic macular oedema, Intravitreal Injections, Original Article, Female, medicine.symptom, Tomography, Optical Coherence, medicine.drug, Angiogenesis Inhibitor, Human, medicine.medical_specialty, Time Factor, Fundus Oculi, Drug Administration Schedule, Macular Edema, Follow-Up Studie, 03 medical and health sciences, Ophthalmology, Ranibizumab, Humans, In patient, Retrospective Studies, Monitoring, Physiologic, Diabetic Retinopathy, Dose-Response Relationship, Drug, business.industry, Intravitreal Injection, Original Articles, eye diseases, Confidence interval, Diabetic macular oedema, 030221 ophthalmology & optometry, business, Resource utilization, Follow-Up Studies
Abstract

Purpose: Antivascular endothelial growth factor agents are increasingly used in diabetic macular oedema (DME); however, there are few studies exploring their use in DME in real-world settings. Methods: POLARIS was a noninterventional, multicentre study to monitor 12-month outcomes in patients starting ranibizumab treatment in routine practices. The primary outcome was mean change in visual acuity (VA) from baseline to month 12 (last observation carried forward approach). Other outcomes included mean change in central retinal thickness (CRT) and resource utilization. Visual acuity (VA) outcomes were also stratified by country, baseline visual acuity score (VAS), sex, age and injection frequency. Results: Outcomes were analysed from all treated patients (n=804) and from first-year completers (patients who had a visual acuity assessment at 12months; n=568). The mean (SD) baseline VAS was 59.4 (15.9) letters, and the mean change in visual acuity was 4.4 letters (95% confidence interval: 3.3–5.4) at month 12 (study eye; first-year completers). The mean number of injections (study eye) was 4.9, and the mean number of all visits (any eye) was 10 (58% were injection visits) over 12months (first-year completers). The mean (SD) baseline CRT was 410.6 (128.8) μm, and the mean change in CRT was −115.2μm at month 12 (study eye; first-year completers). Visual acuity (VA) outcomes were generally comparable across most countries and subgroups and were greatest in patients with the lowest baseline VAS (≤60 letters). Conclusion: POLARIS showed that real-world outcomes in DME patients starting treatment with ranibizumab were lower than those observed in clinical studies, in spite of extensive monitoring.

Published
2018

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