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Article: Multiple Retinal Holes Secondary to Valsalva Retinopathy.

Gurung, Rajya L

Case reports in ophthalmological medicine

2018 Volume 2018, Page(s) 8950682

Abstract: Valsalva retinopathy is a common condition but retinal holes secondary to Valsalva retinopathy are rarely reported. The author believes this to be the first report to describe multiple retinal holes after hyaloidotomy for Valsalva retinopathy. ...

Abstract	Valsalva retinopathy is a common condition but retinal holes secondary to Valsalva retinopathy are rarely reported. The author believes this to be the first report to describe multiple retinal holes after hyaloidotomy for Valsalva retinopathy.
Language	English
Publishing date	2018-05-08
Publishing country	United States
Document type	Case Reports
ZDB-ID	2659091-8
ISSN	2090-6730 ; 2090-6722
ISSN (online)	2090-6730
ISSN	2090-6722
DOI	10.1155/2018/8950682
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Article ; Online: A Guide to Genome-Wide Association Study Design for Diabetic Retinopathy.

Gurung, Rajya L / Burdon, Kathryn P / McComish, Bennet J

Methods in molecular biology (Clifton, N.J.)

2023 Volume 2678, Page(s) 49–89

Abstract: Diabetic retinopathy (DR) is the most common microvascular complication related to diabetes. There is evidence that genetics play an important role in DR pathogenesis, but the complexity of the disease makes genetic studies a challenge. This chapter is a ...

Abstract	Diabetic retinopathy (DR) is the most common microvascular complication related to diabetes. There is evidence that genetics play an important role in DR pathogenesis, but the complexity of the disease makes genetic studies a challenge. This chapter is a practical overview of the basic steps for genome-wide association studies with respect to DR and its associated traits. Also described are approaches that can be adopted in future DR studies. This is intended to serve as a guide for beginners and to provide a framework for further in-depth analysis.
MeSH term(s)	Humans ; Diabetes Mellitus, Type 2/genetics ; Diabetic Retinopathy/genetics ; Genome-Wide Association Study/methods ; Phenotype
Language	English
Publishing date	2023-06-16
Publishing country	United States
Document type	Journal Article ; Review
ISSN	1940-6029
ISSN (online)	1940-6029
DOI	10.1007/978-1-0716-3255-0_5
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Article: A unique case of valsalva retinopathy in a conch blower.

Gurung, Rajya L

American journal of ophthalmology case reports

2017 Volume 7, Page(s) 140–142

Abstract: Purpose: Valsalva hemorrhagic retinopathy is a form of preretinal hemorrhage that develops after a valsalva maneuver, leading to rupture of the superficial retinal capillaries. Here, we report a case of valsalva retinopathy secondary to blowing a conch, ...

Abstract	Purpose: Valsalva hemorrhagic retinopathy is a form of preretinal hemorrhage that develops after a valsalva maneuver, leading to rupture of the superficial retinal capillaries. Here, we report a case of valsalva retinopathy secondary to blowing a conch, the first case report of its kind. The patient blew conch, which was part of his daily ritual to pray to God as he was a Hindu priest. Observations: A 58-year-man developed an acute decrease in vision to 5/60 in his right eye after blowing the conch while performing "Puja," which is the act of praying to God in Hindu culture. Ophthalmoscopy showed a fresh preretinal hemorrhage over the macula in his right eye. YAG laser membranotomy was performed, and his vision returned to 6/6. Conclusions and importance: Conch "Shankha" is a religious instrument used routinely in Hindu culture. Its mechanism is very much similar to that of a wind instrument. This is the first case report of valsalva retinopathy caused by conch blowing.
Language	English
Publishing date	2017-07-08
Publishing country	United States
Document type	Case Reports
ISSN	2451-9936
ISSN	2451-9936
DOI	10.1016/j.ajoc.2017.07.003
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Article ; Online: Angiographic characteristics of contralateral asymptomatic eyes in acute Central serous chorio-retinopathy in an Asian population

Rajya L Gurung / Afaque Anwar

Asian Journal of Medical Sciences, Vol 10, Iss 1, Pp 33-

2018 Volume 37

Abstract: Background: Acute Central serous chorioretinopathy (CSCR) is characterised by an idiopathic circumscribed serous retinal detachment, usually confined to the central macula. Aims and Objective: We aimed to analyse the angiographic characteristics of ... ...

Abstract	Background: Acute Central serous chorioretinopathy (CSCR) is characterised by an idiopathic circumscribed serous retinal detachment, usually confined to the central macula. Aims and Objective: We aimed to analyse the angiographic characteristics of contra-lateral asymptomatic eyes of patients presenting with acute CSCR in an Asian population. Materials and methods: This is a retrospective study of 70 consecutive patients presenting with acute CSCR who underwent detailed fundus evaluation and fluorescein angiography within 1 year period. Results: Fluorescein angiograms of 70 patients were analysed . Male to female ratio was 10.66 : 1. The age range of patients was ( 24-54 ) years , median 37 years and mean age 38.37 years with standard deviation 6.78 . Active tobacco use was found in 34 (48.6%) eyes and systemic steroid use in 2 (2.8%) eyes. Majority, 48 (34.3% ) of symptomatic and all 70(100% ) of contralateral asymptomatic eyes had presenting best corrected visual acuity ( BCVA ) of ≥ 20/60. All 70 (100%) of symptomatic eyes had angiographic evidence of leakage in comparison to only 25(35.7%) of contralateral asymptomatic eyes. Multi-focal leakage was seen in 21 (30%) of symptomatic eyes and 6(8%) of asymptomatic eyes , inkblot leakage pattern being the most common in seen in 57 (81.4%) of symptomatic and 16 (22.8%) of asymptomatic eyes. The most common site of leakage was central seen in 62 (88.5%) of symptomatic eyes and 19 (27.1%) of contralateral asymptomatic eyes. Conclusion: The findings in our study was comparable to other Asian studies. A considerable number of patients had angiographic evidence of CSCR in the contralateral asymptomatic eye.
Keywords	central serous chorio-retinopathy ; fluorescein angiography ; visual acuity ; asian ; Medicine ; R
Language	English
Publishing date	2018-12-01T00:00:00Z
Publisher	Manipal College of Medical Sciences, Pokhara
Document type	Article ; Online
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Article: Predictive factors for treatment outcomes with intravitreal anti-vascular endothelial growth factor injections in diabetic macular edema in clinical practice.

Gurung, Rajya L / FitzGerald, Liesel M / Liu, Ebony / McComish, Bennet J / Kaidonis, Georgia / Ridge, Bronwyn / Hewitt, Alex W / Vote, Brendan J / Verma, Nitin / Craig, Jamie E / Burdon, Kathryn P

International journal of retina and vitreous

2023 Volume 9, Issue 1, Page(s) 23

Abstract: Background: Intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections are the standard of care for diabetic macular edema (DME), a common complication of diabetes. This study aimed to identify factors influencing DME intravitreal anti- ... ...

Abstract	Background: Intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections are the standard of care for diabetic macular edema (DME), a common complication of diabetes. This study aimed to identify factors influencing DME intravitreal anti-VEGF treatment outcomes in real-world practice. Methods: This was a multi-center retrospective observational study using medical chart review of participants receiving anti-VEGF injections for DME (N = 248). Demographic and clinical variables were assessed for association with best corrected visual acuity (BCVA) and central macular thickness (CMT) outcomes using regression models. Results: There was a significant improvement in BCVA (p < 0.001) and CMT (p < 0.001) after 12 months of treatment, although 21% of participants had decreased BCVA, and 41% had a < 10% CMT reduction at 12 months. Higher baseline BCVA (p = 0.022, OR=-0.024, 95% CI=-0.046,-0.004) and longer duration of diabetic retinopathy (p = 0.048, OR=-0.064, 95% CI=-0.129,-0.001) were negative predictors for BCVA response, whereas Aflibercept treatment (p = 0.017, OR = 1.107, 95% CI = 0.220,2.051) compared with other drugs and a positive "early functional response" (p < 0.001, OR=-1.393, 95% CI=-1.946,-0.857) were positive predictors. A higher baseline CMT (p < 0.001, OR = 0.019, 95% CI = 0.012,0.0261) and an "early anatomical response", (p < 0.001, OR=-1.677, 95% CI=-2.456, -0.943) were predictors for greater reduction in CMT. Overall, the variables could predict only 23% of BCVA and 52% of CMT response. Conclusions: The study shows a significant proportion of DME patients do not respond to anti-VEGF therapy and identifies several clinical predictors for treatment outcomes. Trial registration: The study was approved through the Human Research Ethics Committee, University of Tasmania (approval number H0012902), and the Southern Adelaide Clinical Human Research Ethics Committee (approval number 86 - 067).
Language	English
Publishing date	2023-04-04
Publishing country	England
Document type	Journal Article
ZDB-ID	2836254-8
ISSN	2056-9920
ISSN	2056-9920
DOI	10.1186/s40942-023-00453-0
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Article ; Online: Identifying Genetic Risk Factors for Diabetic Macular Edema and the Response to Treatment.

Gurung, Rajya L / FitzGerald, Liesel M / McComish, Bennet J / Verma, Nitin / Burdon, Kathryn P

Journal of diabetes research

2020 Volume 2020, Page(s) 5016916

Abstract: Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus (DM). DR is complex and the term encompasses several clinical subtypes of diabetic eye disease, including diabetic macular edema (DME), the most frequent cause ... ...

Abstract	Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus (DM). DR is complex and the term encompasses several clinical subtypes of diabetic eye disease, including diabetic macular edema (DME), the most frequent cause of central vision loss in DR patients. Both genetic and environmental factors contribute to the pathophysiology of DR and its subtypes. While numerous studies have identified several susceptibility genes for DR, few have investigated the impact of genetics on DME susceptibility. This review will focus on the current literature surrounding genetic risk factors associated with DME. We will also highlight the small number of studies investigating the genetics of response to antivascular endothelial growth factor (anti-VEGF) injection, which is used to treat DME.
MeSH term(s)	Aldehyde Reductase/genetics ; Angiogenesis Inhibitors/therapeutic use ; Apolipoproteins E/genetics ; Bevacizumab/therapeutic use ; Diabetic Retinopathy/drug therapy ; Diabetic Retinopathy/genetics ; Erythropoietin/genetics ; Eye Proteins/genetics ; Genetic Predisposition to Disease ; Humans ; Macular Edema/drug therapy ; Macular Edema/genetics ; MicroRNAs/genetics ; Nerve Growth Factors/genetics ; Nitric Oxide Synthase/genetics ; Ranibizumab/therapeutic use ; Receptors, Vascular Endothelial Growth Factor/therapeutic use ; Recombinant Fusion Proteins/therapeutic use ; Serpins/genetics ; Superoxide Dismutase/genetics ; Treatment Outcome ; Vascular Endothelial Growth Factor A/genetics ; Vascular Endothelial Growth Factor C/genetics
Chemical Substances	Angiogenesis Inhibitors ; Apolipoproteins E ; EPO protein, human ; Eye Proteins ; MicroRNAs ; Nerve Growth Factors ; Recombinant Fusion Proteins ; Serpins ; VEGFA protein, human ; VEGFC protein, human ; Vascular Endothelial Growth Factor A ; Vascular Endothelial Growth Factor C ; pigment epithelium-derived factor ; Erythropoietin (11096-26-7) ; aflibercept (15C2VL427D) ; Bevacizumab (2S9ZZM9Q9V) ; AKR1B1 protein, human (EC 1.1.1.21) ; Aldehyde Reductase (EC 1.1.1.21) ; Nitric Oxide Synthase (EC 1.14.13.39) ; Superoxide Dismutase (EC 1.15.1.1) ; superoxide dismutase 2 (EC 1.15.1.1) ; Receptors, Vascular Endothelial Growth Factor (EC 2.7.10.1) ; Ranibizumab (ZL1R02VT79)
Language	English
Publishing date	2020-11-12
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2711897-6
ISSN	2314-6753 ; 2314-6745
ISSN (online)	2314-6753
ISSN	2314-6745
DOI	10.1155/2020/5016916
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Article ; Online: Comparing vision and macular thickness in neovascular age-related macular degeneration, diabetic macular oedema and retinal vein occlusion patients treated with intravitreal antivascular endothelial growth factor injections in clinical practice.

Gurung, Rajya L / FitzGerald, Liesel M / McComish, Bennet J / Hewitt, Alex W / Verma, Nitin / Burdon, Kathryn P

BMJ open ophthalmology

2021 Volume 6, Issue 1, Page(s) e000749

Abstract: Objective: To compare the visual outcomes of intravitreal antivascular endothelial growth factor (anti-VEGF) injections in neovascular age-related macular degeneration (nAMD), diabetic macular oedema (DMO) and retinal vein occlusion (RVO) in a real- ... ...

Abstract	Objective: To compare the visual outcomes of intravitreal antivascular endothelial growth factor (anti-VEGF) injections in neovascular age-related macular degeneration (nAMD), diabetic macular oedema (DMO) and retinal vein occlusion (RVO) in a real-world setting. Methods and analysis: Retrospective analysis of data from the Tasmanian Ophthalmic Biobank database. The median change in best-corrected visual acuity (BCVA) between baseline and 12 months post initiating intravitreal anti-VEGF treatment were compared between the three diseases. Final BCVA, central macular thickness (CMT), cumulative number of injections and overall predictors of change in BCVA and CMT were also determined. Results: At 12 months, change in BCVA was significantly different between nAMD, DMO and RVO cohorts (p=0.032), with lower median change for DMO (2 letters, range -5 to 20) than for RVO (11 letters, range -20 to 35). Likewise, CMT change was significantly different between the three cohorts (p=0.022), with a smaller reduction in CMT in DMO (-54 µm, range -482 to 50) than RVO patients (-137 µm, range -478 to 43; p=0.033). Total number of injections received (p=0.028) and final BCVA score (p=0.024) were also significantly different between the groups. Baseline BCVA was a negative predictor (p=0.042) and baseline CMT a positive predictor (p<0.001) of outcome. After adjusting for baseline BCVA and CMT, diagnosis of nAMD or RVO was a predictor of visual improvement compared with the DMO. Conclusions: At the end of 12 months, nAMD and RVO cohorts had the greatest improvement in BCVA, however the final BCVA for DMO was significantly better than for nAMD.
Language	English
Publishing date	2021-05-03
Publishing country	England
Document type	Journal Article
ISSN	2397-3269
ISSN (online)	2397-3269
DOI	10.1136/bmjophth-2021-000749
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Article ; Online: The effect of insulin on response to intravitreal anti-VEGF injection in diabetic macular edema in type 2 diabetes mellitus.

Gurung, Rajya L / FitzGerald, Liesel M / Liu, Ebony / McComish, Bennet J / Kaidonis, Georgia / Ridge, Bronwyn / Hewitt, Alex W / Vote, Brendan Jt / Verma, Nitin / Craig, Jamie E / Burdon, Kathryn P

BMC ophthalmology

2022 Volume 22, Issue 1, Page(s) 94

Abstract: Objectives: To assess whether insulin therapy impacts the effectiveness of anti-vascular endothelial growth factor (anti-VEGF) injection for the treatment of diabetic macular edema (DME) in type 2 diabetes mellitus.: Methods: This was a retrospective ...

Abstract	Objectives: To assess whether insulin therapy impacts the effectiveness of anti-vascular endothelial growth factor (anti-VEGF) injection for the treatment of diabetic macular edema (DME) in type 2 diabetes mellitus. Methods: This was a retrospective multi-center analysis. The best-corrected visual acuity (BCVA) at 12 months, BCVA change, central macular thickness (CMT), CMT change, and cumulative injection number were compared between the insulin and the oral hypoglycemic agent (OHA) groups. Results: The mean final BCVA and CMT improved in both the insulin (N = 137; p < 0.001; p < 0.001, respectively) and the OHA group (N = 61; p = 0.199; p < 0.001, respectively). The two treatment groups were comparable for final BCVA (p = 0.263), BCVA change (p = 0.184), final CMT (p = 0.741), CMT change (p = 0.458), and the cumulative injections received (p = 0.594). The results were comparable between the two groups when stratified by baseline vision (p > 0.05) and baseline HbA1c (p > 0.05). Conclusion: Insulin therapy does not alter treatment outcomes for anti-VEGF therapy in DME.
MeSH term(s)	Angiogenesis Inhibitors/therapeutic use ; Diabetes Mellitus, Type 2/complications ; Diabetes Mellitus, Type 2/drug therapy ; Diabetic Retinopathy/complications ; Diabetic Retinopathy/drug therapy ; Humans ; Insulin/therapeutic use ; Intravitreal Injections ; Macular Edema/drug therapy ; Macular Edema/etiology ; Retrospective Studies ; Treatment Outcome ; Visual Acuity
Chemical Substances	Angiogenesis Inhibitors ; Insulin
Language	English
Publishing date	2022-02-28
Publishing country	England
Document type	Journal Article ; Multicenter Study
ZDB-ID	2050436-6
ISSN	1471-2415 ; 1471-2415
ISSN (online)	1471-2415
ISSN	1471-2415
DOI	10.1186/s12886-022-02325-x
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Article ; Online: Identifying Genetic Biomarkers Predicting Response to Anti-Vascular Endothelial Growth Factor Injections in Diabetic Macular Edema

Rajya L. Gurung / Liesel M. FitzGerald / Ebony Liu / Bennet J. McComish / Georgia Kaidonis / Bronwyn Ridge / Alex W. Hewitt / Brendan J. Vote / Nitin Verma / Jamie E. Craig / Kathryn P. Burdon

International Journal of Molecular Sciences, Vol 23, Iss 4042, p

2022 Volume 4042

Abstract: Intraocular anti-vascular endothelial growth factor (VEGF) therapies are the front-line treatment for diabetic macular edema (DME); however, treatment response varies widely. This study aimed to identify genetic determinants associated with anti-VEGF ... ...

Abstract	Intraocular anti-vascular endothelial growth factor (VEGF) therapies are the front-line treatment for diabetic macular edema (DME); however, treatment response varies widely. This study aimed to identify genetic determinants associated with anti-VEGF treatment response in DME. We performed a genome-wide association study on 220 Australian patients with DME treated with anti-VEGF therapy, genotyped on the Illumina Global Screening Array, and imputed to the Haplotype Reference Consortium panel. The primary outcome measures were changes in central macular thickness (CMT in microns) and best-corrected visual acuity (BCVA in ETDRS letters) after 12 months. Association between single nucleotide polymorphism (SNP) genotypes and DME outcomes were evaluated by linear regression, adjusting for the first three principal components, age, baseline CMT/BCVA, duration of diabetic retinopathy, and HbA1c. Two loci reached genome-wide significance ( p < 5 × 10 −8 ) for association with increased CMT: a single SNP on chromosome 6 near CASC15 (rs78466540, p = 1.16 × 10 −9 ) and a locus on chromosome 12 near RP11-116D17.1 (top SNP rs11614480, p = 2.69 × 10 −8 ). Four loci were significantly associated with reduction in BCVA: two loci on chromosome 11, downstream of NTM (top SNP rs148980760, p = 5.30 × 10 −9 ) and intronic in RP11-744N12.3 (top SNP rs57801753, p = 1.71 × 10 −8 ); one near PGAM1P1 on chromosome 5 (rs187876551, p = 1.52 × 10 −8 ); and one near TBC1D32 on chromosome 6 (rs118074968, p = 4.94 × 10 −8 ). In silico investigations of each locus identified multiple expression quantitative trait loci and potentially relevant candidate genes warranting further analysis. Thus, we identified multiple genetic loci predicting treatment outcomes for anti-VEGF therapies in DME. This work may potentially lead to managing DME using personalized treatment approaches.
Keywords	anti-vascular endothelial growth factor ; diabetic macular edema ; genome-wide association ; Biology (General) ; QH301-705.5 ; Chemistry ; QD1-999
Subject code	333 ; 616
Language	English
Publishing date	2022-04-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
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Article ; Online: Identifying Genetic Biomarkers Predicting Response to Anti-Vascular Endothelial Growth Factor Injections in Diabetic Macular Edema.

Gurung, Rajya L / FitzGerald, Liesel M / Liu, Ebony / McComish, Bennet J / Kaidonis, Georgia / Ridge, Bronwyn / Hewitt, Alex W / Vote, Brendan J / Verma, Nitin / Craig, Jamie E / Burdon, Kathryn P

International journal of molecular sciences

2022 Volume 23, Issue 7

Abstract	Intraocular anti-vascular endothelial growth factor (VEGF) therapies are the front-line treatment for diabetic macular edema (DME); however, treatment response varies widely. This study aimed to identify genetic determinants associated with anti-VEGF treatment response in DME. We performed a genome-wide association study on 220 Australian patients with DME treated with anti-VEGF therapy, genotyped on the Illumina Global Screening Array, and imputed to the Haplotype Reference Consortium panel. The primary outcome measures were changes in central macular thickness (CMT in microns) and best-corrected visual acuity (BCVA in ETDRS letters) after 12 months. Association between single nucleotide polymorphism (SNP) genotypes and DME outcomes were evaluated by linear regression, adjusting for the first three principal components, age, baseline CMT/BCVA, duration of diabetic retinopathy, and HbA1c. Two loci reached genome-wide significance (p < 5 × 10−8) for association with increased CMT: a single SNP on chromosome 6 near CASC15 (rs78466540, p = 1.16 × 10−9) and a locus on chromosome 12 near RP11-116D17.1 (top SNP rs11614480, p = 2.69 × 10−8). Four loci were significantly associated with reduction in BCVA: two loci on chromosome 11, downstream of NTM (top SNP rs148980760, p = 5.30 × 10−9) and intronic in RP11-744N12.3 (top SNP rs57801753, p = 1.71 × 10−8); one near PGAM1P1 on chromosome 5 (rs187876551, p = 1.52 × 10−8); and one near TBC1D32 on chromosome 6 (rs118074968, p = 4.94 × 10−8). In silico investigations of each locus identified multiple expression quantitative trait loci and potentially relevant candidate genes warranting further analysis. Thus, we identified multiple genetic loci predicting treatment outcomes for anti-VEGF therapies in DME. This work may potentially lead to managing DME using personalized treatment approaches.
MeSH term(s)	Adaptor Proteins, Signal Transducing ; Angiogenesis Inhibitors/therapeutic use ; Australia ; Diabetes Mellitus/drug therapy ; Diabetic Retinopathy/diagnosis ; Diabetic Retinopathy/drug therapy ; Diabetic Retinopathy/genetics ; Genetic Markers ; Genome-Wide Association Study ; Humans ; Intravitreal Injections ; Macular Edema/drug therapy ; Macular Edema/genetics ; Ranibizumab/therapeutic use ; Retrospective Studies ; Tomography, Optical Coherence ; Vascular Endothelial Growth Factors ; Visual Acuity
Chemical Substances	Adaptor Proteins, Signal Transducing ; Angiogenesis Inhibitors ; Genetic Markers ; TBC1D32 protein, human ; Vascular Endothelial Growth Factors ; Ranibizumab (ZL1R02VT79)
Language	English
Publishing date	2022-04-06
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2019364-6
ISSN	1422-0067 ; 1422-0067 ; 1661-6596
ISSN (online)	1422-0067
ISSN	1422-0067 ; 1661-6596
DOI	10.3390/ijms23074042
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