Macular Degeneration: Kaiserman I

Kaiserman N, Vinker S, Kaiserman I. · Hebrew University Medical School, Jerusalem, Israel. · Curr Eye Res. · Pubmed #19373579 No free full text.

Abstract: PURPOSE: To investigate the effect of statins on the risk for age-related macular degeneration (AMD) treated with photodynamic therapy (PDT). METHODS: All members in one district of a health maintenance organization in Israel, older than 50 years (n = 139,894), were included. PDT procedures for AMD (775 procedures; 283 patients) and filled statin prescriptions between 1999 and 2002 (471,232 prescriptions; 29,417 patients) were documented. RESULTS: For all age groups, PDT was more prevalent in statin users. Among statin users, the age adjusted proportion of patients undergoing PDT for wet AMD was 0.27% (95% confidence interval (CI): 0.20-0.34%), compared to 0.16% (95% CI: 0.14-0.18%) among non-users (p = 0.002, chi2 test, relative risk = 1.66 (95% CI: 1.29-2.19)). After correction for age, gender, socioeconomic status, place of birth, place of residence, hyperlipidemia, hypertension, ischemic heart disease, diabetes, and congestive heart failure, statins did not have any additional effect on the risk for undergoing PDT for wet AMD. In a case control analysis, statin use in PDT patients was similar to their use by matched controls (odds ratio = 1.0; 95% CI = 0.8-1.3). CONCLUSIONS: This study does not support a beneficial effect of statin use for reducing the risk for wet AMD requiring PDT.

Kaiserman I, Kaiserman N, Elhayany A, Vinker S. · Department of Ophthalmology, Barzilai Medical Center, Ashkelon, Israel. · Ophthalmology. · Pubmed #17270677 No free full text.

Abstract: PURPOSE: To investigate the association between cataract surgery and the rate of photodynamic therapy (PDT) for age-related macular degeneration (AMD). DESIGN: Observational population-based retrospective case-control study. PARTICIPANTS: All members in a district of the largest health maintenance organization (HMO) in Israel > 50 years old on January 1, 2001, who did not terminate their membership through May 31, 2005 (139 894 members). METHODS: All PDT procedures for AMD performed in the study population between January 1, 2001 and May 31, 2005 (283 patients) and all cataract surgeries performed between January 1, 2001 and December 31, 2003 (5913 patients) were documented. We extracted clinical information from the chronic disease registry of the HMO as well as demographic and socioeconomic information. For each patient that underwent cataract surgery, 5 HMO members matched in age, gender, chronic diseases (systemic hypertension, diabetes, hyperlipemia, and ischemic heart disease), place of residence, country of birth and socioeconomic status, who did not undergo cataract surgery, were randomly chosen as controls (n = 29 565). MAIN OUTCOME MEASURES: The rate for undergoing PDT at different time periods after cataract surgery. RESULTS: Fifty (0.85%) cataract patients and 94 control cases (0.32%) underwent PDT after cataract surgery (P<0.0001, chi-square test). A significant rise in PDT rate was noticed in cataract patients compared to controls during the first 6 months after surgery (P = 0.004, chi-square test). Between 6 and 12 months postoperatively, the PDT rates were similar in both groups. However, a more significant rise in PDT rates occurred between 1 and 1.5 years after surgery (P<0.0001, chi-square test). The Kaplan-Meier PDT-free survival curve of cataract patients was significantly worse than that of the controls (P<0.0001, chi-square test; P = 33.7, log-rank test). The hazard ratio for cataract patients compared to controls to undergo PDT after surgery was 2.7 (confidence interval = 2.4-5.7). The most significant factors to reduce the time to PDT were advanced age followed by having had cataract surgery, place of birth, socioeconomic status, and hyperlipidemia (Cox proportional hazards survival regression). CONCLUSIONS: We identified an increased rate of PDT, presumably for subfoveal AMD, 1 to 1.5 years after cataract surgery.

Kaiserman I, Kaiserman N, Elhayany A, Vinker S. · Department of Ophthalmology, Barzilai Medical Center, Ashkelon, Israel. · Am J Ophthalmol. · Pubmed #16935589 No free full text.

Abstract: PURPOSE: To investigate the influence of various risk factors for age-related macular degeneration (AMD) on the rate of undergoing photodynamic therapy (PDT). DESIGN: An observational population based cohort study. METHODS: Settings: A district of the largest health maintenance organization (HMO) in Israel. Study Population: All HMO members in the district, older than 50 years on January 1, 2001, who did not terminate their membership until May 31, 2005 (139,894 members); of those, 283 underwent PDT for AMD during the study period (775 procedures). Observation Procedures: We extracted information from the chronic disease registry of the HMO as well as demographic information including age, gender, country of birth, place of residency, and social security economic status. Main Outcome Measures: Effect of various risk factors for AMD on the rate of PDT. RESULTS: The age-adjusted proportion of patients requiring PDT was significantly higher in hypertensives (P = .03, chi2 test), in hyperlipidemics (P = .002), in ischemic heart disease patients (P = .002) and among males (P = .03) and Ashkenazi Jews (P = .02). No significant difference in PDT rates was noted in diabetics, congestive heart failure (CHF), and chronic renal failure (CRF) patients. PDT rates were lower in the lower socioeconomic class (P = .002). Logistic regression found a significant effect of age, hyperlipidemia, hypertension, socioeconomic status, and gender on the rate of PDT, while ischemic heart disease (IHD), diabetes, CHF, CRF, place of birth, and place of residence did not contribute significantly to the model. CONCLUSIONS: Advanced age, hypertension, hyperlipidemia, male gender, and socioeconomic status are risk factors for undergoing PDT for predominantly classic neovascular AMD.

Rumelt S, Kaiserman I, Rehany U, Ophir A, Pikkel J, Loewenstein A. · Department of Ophthalmology, Hadassah University Hospital, Jerusalem, Israel. · Am J Ophthalmol. · Pubmed #12470749 No free full text.

Abstract: PURPOSE: To report the entity of partial detachment and folding of subfoveal choroidal neovascularization (CNV) in age-related macular degeneration (ARMD). DESIGN: Interventional case reports. METHODS: Review of the features of CNV detachment in two patients with CNV due to ARMD by contact lens slit-lamp biomicroscopy, fluorescein angiography, optical coherence tomography, and three-dimensional confocal scanning laser indocyanine green (ICG) angiography. RESULTS: One patient out of approximately 300 (0.5%) ARMD patients treated by photodynamic therapy (PDT) developed partial CNV detachment and folding 6 weeks after the second PDT treatment. Another patient out of approximately 100 (1.0%) ARMD patients treated by transpupillary thermotherapy (TTT) developed partial CNV detachment and folding 6 weeks after the second TTT treatment. The CNVs were large (2,500 microm to 4,500 microm) and located between the retina and the retinal pigment epithelium. In each, these findings were clearly visualized by slit-lamp biomicroscopy. Fluorescein angiography demonstrated an associated retinal pigment epithelium tear in one patient. Optical coherence tomography showed distinctive features and confocal scanning laser ICG further delineated the detached folded CNV. The best-corrected visual acuity improved in one patient from 20/80 to 20/40 and in the other from counting fingers at 6 feet to 20/200 after the CNV detachment. CONCLUSIONS: Partial CNV detachment and folding represent a unique, not previously reported, and possibly favorable outcome of PDT and TTT. The low energy and selectivity of these treatments may explain this phenomenon.